Evidence map›Paper›PMID 40780589›Full record

SynthesisThe Journal of infection2025

Clinical phenotype and outcomes in autoimmune encephalitis after herpes simplex virus encephalitis: A systematic review and meta-analysis.

Jonathan Cleaver, Renetta Chungath, Amy Gimson, Christine Strippel, Bryan Ceronie, Babak Soleimani, Thomas Johnson, Eyal Muscal, Kristen Fisher, Yike Jiang and 21 more

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Journal of infection, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Autoimmune Encephalitis in Acute Care-Pathology, Diagnosis, and Management.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026
    Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

31 authors.

Jonathan CleaverOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK.
Renetta ChungathOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Amy GimsonDepartment of Neurology, Southmead Hospital, Bristol, UK.
Christine StrippelOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK.
Bryan CeronieOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK.
Babak SoleimaniOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom. Nuffield Department of Clinical Neurosciences, West Wing, John Radcliffe Hospital, University of Oxford, Oxford, UK.
Thomas JohnsonWellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom. Nuffield Department of Clinical Neurosciences, West Wing, John Radcliffe Hospital, University of Oxford, Oxford, UK.
Eyal MuscalDepartment of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; Department of Pediatrics, Section of Rheumatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
Kristen FisherDepartment of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
Yike JiangDepartment of Pediatrics, Division of Pediatric Rheumatology, Duke University School of Medicine, Durham, NC, USA.
Timothy A EricksonLaboratories for Emerging and Tropical Disease Research, Department of Epidemiology & Biostatistics, Texas A&M School of Public Health, College Station, TX, USA.
Kristy O MurrayDepartment of Pediatrics, Division of Innovation and Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
Siv Tonje Faret HovetDepartment of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark.
Charlotte Aaberg PoulsenDepartment of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark.
Anna Søgaard MagnussenDepartment of Neurology, Odense University Hospital (OUH), Denmark; Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Pauline DumezFrench Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, MeLiS-UCBL-CNRS UMR 5284. INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France.
Shannon RoncaDepartment of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.
Martin HäuslerDepartment of Pediatrics, Division of Neuropediatrics and Social Pediatrics, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Annegret QuadeDepartment of Pediatrics, Division of Neuropediatrics and Social Pediatrics, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Andrew SwayneMater Centre for Neurosciences, Mater Hospital, Brisbane, Queensland, Australia.
Morten BlaabjergDepartment of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; Department of Neurology, Odense University Hospital (OUH), Denmark.
Mette NissenDepartment of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; Department of Neurology, Odense University Hospital (OUH), Denmark.
Alexander J SandweissDepartment of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
Jerome HonnoratFrench Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, MeLiS-UCBL-CNRS UMR 5284. INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France.
Russell DaleBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Clinical Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; TY Nelson Department of Neurology, Children's Hospital at Westmead, Sydney, NSW, Australia.
Ming LimChildren's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Women & Children's Health, School of School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Michael EyreChildren's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, UK; Departments of Imaging Physics & Engineering and Early Life Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Margherita NosadiniPaediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy; Neuroimmunology Group, Paediatric Research Institute "Città della Speranza," Padova, Italy.
Lahiru HandunnetthiDepartment of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK; Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom. Nuffield Department of Clinical Neurosciences, West Wing, John Radcliffe Hospital, University of Oxford, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK.
Sarosh R IraniOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Departments of Neurology and Neurosciences, Mayo Clinic, Jacksonville, FL, USA.
Adam E HandelOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK. Electronic address: Adam.Handel@ndcn.ox.ac.uk.

Funding

Medical Research Council MR/V007173/1Medical Research Council MR/X022013/1Wellcome Trust 104079
6 · The paper itself

Abstract

backgroundAutoimmune encephalitis after herpes simplex virus encephalitis (HSVE-AE) represents the intersection of central nervous system infection and autoimmunity. Defining the phenotype and the safety and effectiveness of immunotherapy in HSVE-AE would help identify immunotherapy candidates, optimise therapeutic strategies, and improve patient outcomes.

methodsWe systematically searched Embase, Medline, PubMed, and Web of Science (2007-2024) for cases meeting consensus criteria for AE after confirmed HSVE. Demographics, phenotype, treatment and outcome data were extracted. Dimensionality reduction, network analysis, and multivariate logistic regression was used to explore age- and diagnosis-specific patterns and outcome predictors.

resultsFrom 2259 articles screened, 78 studies (225 patients) were included (median age 7.25 years; 52.9% female). Children (0-12 years) experienced more seizures during HSVE (p=0.003) and movement disorders during AE (p<0.001). Older patients (>12 years) had more headaches during HSVE (p=0.003), and speech dysfunction (p=0.02) and neuropsychiatric symptoms (p=0.02) during AE. HSVE-AE (89.3% N-methyl-D-aspartate receptor-antibody encephalitis [NMDAR-AbE]) differed significantly from a canonical NMDAR-AbE cohort (n=1550) in clinical, paraclinical and outcome domains. Poor outcomes were linked to infant and older adult age, neuropsychiatric symptoms, and AE-phase mRS >4. Rituximab independently predicted better outcomes. Disability improved over time (p<0.001), with adverse event rates comparable to NMDAR-AbE. CONCLUSIONS AND RELEVANCE: This meta-analysis defines novel age-specific HSVE-AE features, outcome predictors, and confirms the safety and improved outcomes of HSVE-AE after immunotherapy.

Indexed as

Autoimmune Diseases of the Nervous SystemEncephalitis, Herpes SimplexFemaleHumansImmunotherapyPhenotypeTreatment OutcomeAutoimmune encephalitisHerpes simplex virus encephalitisImmunotherapyInfectious encephalitisNeuroimmunologyNMDA receptor-antibody encephalitis

Identifiers

PMID40780589
PMCPMC7618681

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.