Recognizing autoimmune-induced neuropsychiatric symptoms
Infections and a dysfunctional autoimmune reaction can cause encephalitis (brain inflammation) which may result in behavioral changes or neuropsychiatric symptoms. 1
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Encephalitis of the brain can trigger changes in behavior

Encephalitis, which refers to inflammation of the brain, can occur in various regions of the brain. Encephalitis of the brain is typically caused by an infection (infectious encephalitis) or autoimmune reaction (autoimmune encephalitis).

Autoimmune encephalitis (AE) occurs when the body’s immune system produces antibodies that mistakenly attack portions of the brain. These autoantibodies target receptors or proteins in different regions of the brain, which can result in a range of neuropsychiatric symptoms. 1

In recent years, the number of confirmed cases of AE [autoimmune encephalitis] has been increasing annually, as a growing number of neuronal autoantibodies are discovered. 2

WATCH VIDEO: Dr. Shimasaki describes how the Cunningham Panel™ of tests can help clinicians diagnose infection-triggered autoimmune conditions, such as basal ganglia encephalitis.

There are different forms of autoimmune encephalitis, each defined by the antibodies involved and the targets within the brain. Basal ganglia encephalitis can occur when autoantibodies attack an area of the brain known as the basal ganglia. PANS and PANDAS are a type of basal ganglia encephalitis. 3

Basal ganglia encephalitis, which is frequently caused by an underlying infection, can trigger neurologic and psychiatric symptoms, such as obsessions/compulsions, anxiety, depression, mood swings and other changes in behavior. 3

Watch Video: Grace’s Story – PANS/PANDAS

It is important to know whether psychiatric symptoms, neurologic manifestations or a change in behavior or personality is due to an autoimmune encephalopathy rather than a primary psychiatric illness. Be sure to check with your doctor, since the prescribed treatments would be different for each of these conditions. And, with the proper treatment, symptoms can be greatly reduced or completely resolved.

For example, some of the approaches to treatment may involve identifying and eradicating possible underlying infections, treating a dysfunctional immune system and reducing inflammation or encephalitis of the brain. Published treatment guidelines have listed immunomodulatory therapies, anti-infective medications, antibiotics, anti-inflammatory drugs, steroids, IVIG or plasmapheresis. 4

Basal ganglia encephalitis, which is frequently caused by an underlying infection, can trigger neurologic and psychiatric symptoms, such as obsessions/compulsions, tics, anxiety, depression, mood swings and other changes in behavior. 3

It can be challenging to identify neuropsychiatric symptoms that may be due to infection-triggered basal ganglia encephalitis.

Investigators suggest several criteria that may support a diagnosis of autoimmune encephalitis. These include a history of other autoimmune disorders, a preceding infection, febrile illness or viral disease-like prodromes, and a positive response to immunotherapy. 5 Criteria for PANS/PANDAS specifies an abrupt and dramatic onset of neuropsychiatric symptoms that are not better explained by a known neurologic or medical disorder. 6

Why is it important to identify and treat?

“Over the past 10 years, identification of autoimmune forms of encephalitis with antibodies against neuronal surface antigens … have shown that CNS disorders … can be antibody mediated and benefit from immunomodulatory therapies.” 7

  1. Treatment is different and often involves anti-infective and immunomodulatory therapies. 4
  2. Early diagnosis and treatment has been shown to improve chances for a full recovery. 8
  3. With proper treatment, symptoms/behaviors are often resolved with significant improvement in symptoms or a complete remission. 9
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  1. Platt MP, Agalliu D, Cutforth T. Hello from the Other Side: How Autoantibodies Circumvent the Blood-Brain Barrier in Autoimmune Encephalitis. Front Immunol. 2017;8:442. Published 2017 Apr 21. doi:10.3389/fimmu.2017.00442
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399040/
  2. Gu Y, Zhong M, He L, et al. Epidemiology of Antibody-Positive Autoimmune Encephalitis in Southwest China: A Multicenter Study. Front Immunol. 2019;10:2611. Published 2019 Nov 12. doi:10.3389/fimmu.2019.02611
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861323/
  3. Chain JL, Alvarez K, Mascaro-Blanco A, et al. Autoantibody Biomarkers for Basal Ganglia Encephalitis in Sydenham Chorea and Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infections. Front Psychiatry. 2020;11:564. Published 2020 Jun 24. doi:10.3389/fpsyt.2020.00564
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328706/
  4. Jennifer Frankovich, Susan Swedo, Tanya Murphy, Russell C. Dale, Dritan Agalliu, Kyle Williams, Michael Daines, Mady Hornig, Harry Chugani, Terence Sanger, Eyal Muscal, Mark Pasternack, Michael Cooperstock, Hayley Gans, Yujuan Zhang, Madeleine Cunningham, Gail Bernstein, Reuven Bromberg, Theresa Willett, Kayla Brown, Bahare Farhadian, Kiki Chang, Daniel Geller, Joseph Hernandez, Janell Sherr, Richard Shaw, Elizabeth Latimer, James Leckman, Margo Thienemann, and PANS/PANDAS Consortium.Journal of Child and Adolescent Psychopharmacology.Sep 2017.574-593.http://doi.org/10.1089/cap.2016.0148
    https://www.liebertpub.com/doi/full/10.1089/cap.2016.0148
  5. Zuliani L, Graus F, Giometto B, Bien C, Vincent A. Central nervous system neuronal surface antibody associated syndromes: review and guidelines for recognition. J Neurol Neurosurg Psychiatry. 2012 Jun;83(6):638-45. doi: 10.1136/jnnp-2011-301237. Epub 2012 Mar 24. PMID: 22448032; PMCID: PMC3348613.
    https://pubmed.ncbi.nlm.nih.gov/22448032/
  6. Chang K, Frankovich J, Cooperstock M, et al. Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference. J Child Adolesc Psychopharmacol. 2015;25(1):3-13. doi:10.1089/cap.2014.0084
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340805/
  7. Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15(4):391-404. doi:10.1016/S1474-4422(15)00401-9
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066574/
  8. Shin Y-W, Lee S-T, Park K-I, et al. Treatment strategies for autoimmune encephalitis. Therapeutic Advances in Neurological Disorders. January 2018. doi:10.1177/1756285617722347
    https://journals.sagepub.com/doi/pdf/10.1177/1756285617722347
  9. Brenton JN, Goodkin HP. Antibody-Mediated Autoimmune Encephalitis in Childhood. Pediatr Neurol. 2016 Jul;60:13-23. doi: 10.1016/j.pediatrneurol.2016.04.004. Epub 2016 Apr 12. PMID: 27343023.
    https://www.pedneur.com/article/S0887-8994(15)30139-9/pdf
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    The Cunningham Panel™ – Antibody testing that helps determine whether an autoimmune response may be triggering neurologic and/or psychiatric symptoms.
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B. Robert Mozayeni, MD

Medical and Clinical Advisor

B. Robert Mozayeni MD

Dr. B. Robert Mozayeni was trained in Internal Medicine and Rheumatology at Yale and at NIH. He has had pre- and post-doctoral Fellowships in Molecular Biophysics and Biochemistry at Yale, and also at NIH where he was a Howard Hughes Research Scholar at LMB/DCBD/NCI and later, Senior Staff Fellow at LMMB/NHLBI/NIH. Editorial board of Infectious Diseases – Surveillance, Prevention and Treatment. Past President of the International Lyme and Associated Diseases Society (ILADS).

He is an expert in Translational Medicine, the science and art of advancing medical science safely and efficiently. He is a Fellow of the non-profit Think Lead Innovate Foundation and is a co-founder of the Foundation for the Study of Inflammatory Diseases. He is a Founder of the Foundation for the Study of Inflammatory Diseases to crowd-source medical solutions for complex conditions using existing knowledge, diagnostic methods, and therapies to meet patient needs immediately. He is the Chief Medical Officer of Galaxy Diagnostics, LLC. He is a Board member of the Human-Kind Alliance. Dr. Mozayeni has held admitting privileges (since 1994) on the clinical staff of Suburban Hospital, a member of Johns Hopkins Medicine and an affiliate of the National Institutes of Health Clinical Center.

Safedin Sajo Beqaj, PhD, HCLD, CC (ABB)

Moleculera Labs, Clinical Laboratory Advisor
Medical Database, Inc., President and CEO

Sajo Baqaj, PhD

Dr. Sajo Beqaj is board certified in molecular pathology and genetics and licensed as a Bioanalyst and High Complexity Laboratory Director. He has been practicing as a laboratory director since 2005.

Dr. Beqaj served as a technical director and was part of the initial management team for several well-known laboratories in the clinical lab industry including PathGroup, Nashville, TN; DCL Medical Laboratories, Indianapolis, IN, and Pathology, Inc, Torrance, CA. He is currently serving as off-side CLIA laboratory director for BioCorp Clinical Laboratory, Whittier, CA and Health360 Labs, Garden Grove, CA.

Dr. Beqaj received his Ph.D. in Pathology from Wayne State University Medical School, Detroit, Michigan. He performed his post-doctoral fellowship at Abbott Laboratories from 2001-2003 and with Children’s Hospital and Northwestern University from 2003-2005.

Dr. Beqaj has taught in several academic institutions and has published numerous medical textbook chapters and journal articles. He has served as a principal investigator in clinical trials for several well-known pharmaceutical and diagnostic companies such as Roche HPV Athena, Merck HPV vaccine, BD vaginitis panel, Roche (Vantana) CINtec® Histology clinical trials, and has presented various scientific clinical abstracts and presentations.

He is a member of several medical and scientific associations including the Association of Molecular Pathology, American Association of Clinical Chemistry and the Pan Am Society for Clinical Virology. He has served on a number of clinical laboratory regulatory and scientific committees, and has assisted several laboratories and physicians as a Clinical Laboratory Consultant.

Rodney Cotton, MBA

Moleculera Labs Board Member

Rodney Cotton, MBA

Rodney Cotton, MBA is an entrepreneurial thought leader in the pharmaceutical/biotech industry who is known for his holistic perspective, bias for action in the face of challenges, and commitment to agile processes.

Rod is an independent director for Orchard Software, a private equity-backed health technology company owned by Francisco Partners; an advisory board member to Flo2 Ventures, a venture capital-backed healthcare and health equity accelerator; and a member of the board of directors and three board committees (Audit, Compliance & Finance; Governance & Equity; and Quality of Care) for Community Health Network.

He built a successful career at Roche spanning more than two decades and culminating in the role of SVP, Head of Strategy & Transformation, and Chief of Staff to the CEO for Roche Diagnostics, the North American headquarters of the world’s largest ($17B) diagnostics company.

While at Roche, Rod led key enterprise initiatives, such as milestone corporate communications, health equity coalitions, the US/Roche Group audit, and global/US acquisition integrations. With 40+ years of experience, he drove the financial turnaround and cultural transformation of four global healthcare companies, led teams of up to 280 total reports, managed P&L of more than $1 billion, and served as a key member of the senior leadership team executing the most significant restructuring of the company in two decades.

In the face of the COVID-19 pandemic, Rod and his team at Roche accelerated six ground breaking products in 11 months, including the first launch of the market’s most accurate and in demand molecular diagnostic test. He also solved extraordinary challenges of product scarcity, supply chain, product allocation, and logistics to achieve accelerated global sourcing and self manufacturing in line with testing guidelines.

A frequent public speaker on health equity and other topics, Rod was named one of the Most Influential Black Executives in Corporate America by Savoy Magazine and one of the Top Blacks in Healthcare by BlackDoctor.org. He also received The Sagamore of the Wabash Award, one of the highest Indiana State honors, bestowed by Indiana Governor Eric J. Holcomb.

Rod holds an M.B.A. from California State University, Dominguez Hills, an M.S. in Strategic Management from the University of Southern California, and a B.A. in Biological Sciences & Technology from the University of California at Santa Barbara.