The neuromythology of Hashimoto encephalopathy: The emperor has no clothes

Six Myths and Misconceptions about Essential Tremor

There are myths and misperceptions about most human diseases, and neurological diseases are no exception. In many instances, myths and misconceptions reflect what is no more than the collective failure of the field to catch up with the state of the science in that field. Hence, one may perhaps refer to these as "lags" rather than myths. As the field of medicine attempts to be evidence-based, it is best to remain true to published data and the state of the science. In this paper, I review six myths and misconceptions about ET. Myth 1 relates to the natural history and prognosis of ET. Myths 2 and 3 relate to the biological basis of ET, whereas myths 4 and 5 relate to the expression of the core clinical feature of ET. Finally, myth 6 focuses on the issue of disease classification. The myths are as follows: Myth 1: "ET is not associated with a shorter life expectancy". Myth 2: "The pathophysiology of ET remains unclear". Myth 3: "There have also been studies that do not show any cerebellar degeneration". Myth 4: "ET is a postural or a kinetic tremor". Myth 5: "Action tremor in ET is usually bilateral and symmetric". Myth 6: "ET plus". As neurologists, we are not ignorant of feedback loops. A regular review of facts should help to frame one's output. As such, one's formulations and output will be firmly grounded in data.

Difficulties in the Diagnostics and Treatment of Hashimoto's Encephalopathy-A Systematic and Critical Review

Hashimoto's encephalopathy (HE) has been a poorly understood disease. It has been described in all age group, yet, there is no specific HE marker. Additionally, the treatment data in the available studies are frequently divergent and contradictory. Therefore, the aim of our systematic and critical review is to evaluate the diagnosis and treatment of HE in view of the latest findings. The databases browsed comprised PubMed, Scopus, and Google Scholar as well as Cochrane Library, and the search strategy included controlled vocabulary and keywords. A total of 2443 manuscripts were found, published since the beginning of HE research until February 2024. In order to determine validity of the data collected from studies, bias assessment was performed using RoB 2 tool. Ultimately, six studies were included in our study. HE should be considered in the differential diagnosis in patients with psychiatric and neurological symptoms. According to our findings, negative thyroid peroxidase antibodies (anti-TPOs) may represent a valuable parameter in ruling out HE. Nonetheless, this result cannot be used to confirm HE. Furthermore, the proposed anti NH2-terminal-α-enolase (anti-NAE) is non-specific for HE. The effectiveness of glucocorticoid therapy is 60.94%, although relapse occurs in 31.67% of patients following the treatment. Our review emphasizes the significance of conducting further large-scale research and the need to take into account the potential genetic factor.

Immune-mediated ataxias: Guide to clinicians

Immune-mediated cerebellar ataxias were initially described as a clinical entity in the 1980s, and since then, an expanding body of evidence has contributed to our understanding of this topic. These ataxias encompass various etiologies, including postinfectious cerebellar ataxia, gluten ataxia, paraneoplastic cerebellar degeneration, opsoclonus-myoclonus-ataxia syndrome and primary autoimmune cerebellar ataxia. The increased permeability of the brain-blood barrier could potentially explain the vulnerability of the cerebellum to autoimmune processes. In this manuscript, our objective is to provide a comprehensive review of the most prevalent diseases within this group, emphasizing clinical indicators, pathogenesis, and current treatment approaches.

Steroid responsive encephalopathy associated with autoimmune thyroiditis as a cause of acuteencephalopathy

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), known as Hashimoto's encephalopathy (HE), represents a heterogeneous group of neurological and neuropsychiatric symptoms associated with a presence of antithyroid antibodies in case of other causes of encephalopathy were excluded. Clinical symptoms most commonly includes acute onset of encephalopathy, behaviour changes and cognitive dysfunction, epileptic seizures as well as cerebellar and extrapyramidal symptoms. Corticoids provides rapid and sustained therapeutic benefit in most patients and only a few patients require other immunosuppressive therapy such as plasmapheresis, intravenous immunoglobulins, or others. We present the cases of two patients with acute onset of encephalopathy, status epilepticus based on SREAT, with rapid improvement after steroid treatment.

Hashimoto Encephalopathy—Still More Questions than Answers

The normal function of the nervous system is conditioned by the undisturbed function of the thyroid gland and its hormones. Comprehensive clinical manifestations, including neurological disorders in Hashimoto’s thyroiditis, have long been understood and, in recent years, attention has been paid to neurological symptoms in euthyroid patients. Hashimoto encephalopathy is a controversial and poorly understood disease entity and the pathogenesis of the condition remains unclear. We still derive our understanding of this condition from case reports, but on the basis of these, a clear clinical picture of this entity can be proposed. Based on a review of the recent literature, the authors present the current view on the subject, discuss controversies and questions that still remain unanswered, as well as ongoing research in this area and the results of our own work in patients with Hashimoto’s thyroiditis.

Hashimoto's Encephalopathy Masquerading as Rapidly Progressive Dementia and Extrapyramidal Failure

Hashimoto's encephalopathy is a rare immune-mediated disorder characterized by subacute encephalopathy with elevated thyroid antibodies. Hashimoto's encephalopathy is also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis. We report a rare presentation of Hashimoto's encephalopathy presenting with acute neuropsychiatric disturbances, rapidly progressive dementia, seizures, and extrapyramidal failure. Neuroimaging revealed multifocal vasculitides of major cerebral vessels that support the autoimmune vasculitic theory as the underlying pathogenesis for Hashimoto's encephalopathy. Unfortunately, permanent irreversible cerebral damage has already ensued before her presentation to our center, which rendered steroid therapy ineffective. Serological testing for Hashimoto's thyroiditis must be in the investigation of all rapidly progressive dementias as early diagnosis and timely management of autoimmune thyroiditis may salvage sizable and eloquent cerebral tissues. The rarity of the condition should not preclude the investigation of Hashimoto's disease even in the presence of normal levels of thyroid hormones. Delayed diagnosis may result in irreversibly catastrophic encephalopathy in patients who once presented with potentially curable dementia.

The multiple faces of encephalitis: Antibody profile in a case series of autoimmune encephalitis in Bogotá, Colombia

There is a lack of population based studies of autoimmune encephalitis (AE) in Latin American countries, especially in Colombia. The aim of this study is to characterize patients with AE managed in three centers in Bogotá-Colombia, emphasizing on antibody profile. We conducted a retrospective case-series study, including 9 patients. The most prevalent antibody found was NMDAR, followed by LGI1. Some distinguishing features included: faciobrachial dystonia and hyponatremia in LGI1, a younger age and good outcome in NMDAR, a notable response to steroids in anti TPO-Thyroglobulin, a cerebellar syndrome associated with Anti-Yo, and epilepsy with insomnia in CASPR2.