Hashimoto's encephalopathy : epidemiology, pathogenesis and management.

Abstract:

:Hashimoto's encephalopathy is a term used to describe an encephalopathy of presumed autoimmune origin characterised by high titres of antithyroid peroxidase antibodies. In a similar fashion to autoimmune thyroid disease, Hashimoto's encephalopathy is more common in women than in men. It has been reported in paediatric, adult and elderly populations throughout the world. The clinical presentation may involve a relapsing and remitting course and include seizures, stroke-like episodes, cognitive decline, neuropsychiatric symptoms and myoclonus. Thyroid function is usually clinically and biochemically normal.Hashimoto's encephalopathy appears to be a rare disorder, but, as it is responsive to treatment with corticosteroids, it must be considered in cases of 'investigation negative encephalopathies'. Diagnosis is made in the first instance by excluding other toxic, metabolic and infectious causes of encephalopathy with neuroimaging and CSF examination. Neuroimaging findings are often not helpful in clarifying the diagnosis. Common differential diagnoses when these conditions are excluded are Creutzfeldt-Jakob disease, rapidly progressive dementias, and paraneoplastic and nonparaneoplastic limbic encephalitis. In the context of the typical clinical picture, high titres of antithyroid antibodies, in particular antithyroid peroxidase antibodies, are diagnostic. These antibodies, however, can be detected in elevated titres in the healthy general population. Treatment with corticosteroids is almost always successful, although relapse may occur if this treatment is ceased abruptly. Other forms of immunomodulation, such as intravenous immune-globulin and plasma exchange, may also be effective. Despite the link to autoimmune thyroid disease, the aetiology of Hashimoto's encephalopathy is unknown. It is likely that antithyroid antibodies are not pathogenic, but titres can be a marker of treatment response. Pathological findings can suggest an inflammatory process, but features of a severe vasculitis are often absent. The links between the clinical pictures, thyroid disease, auto-antibody pattern and brain pathology await further clarification through research. It may be that Hashimoto's encephalopathy will be subsumed into a group of nonvasculitic autoimmune inflammatory meningoencephalopathies. This group may include disorders such as limbic encephalitis associated with voltage-gated potassium channel antibodies. Some authors have suggested abandoning any link to Hashimoto and renaming the condition 'steroid responsive encephalopathy associated with autoimmune thyroiditis' to better reflect current, if limited, understanding of this condition.

journal_name

CNS Drugs

journal_title

CNS drugs

authors

Mocellin R,Walterfang M,Velakoulis D

doi

10.2165/00023210-200721100-00002

subject

Has Abstract

pub_date

2007-01-01 00:00:00

pages

799-811

issue

10

eissn

1172-7047

issn

1179-1934

pii

21102

journal_volume

21

pub_type

杂志文章,评审
  • New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?

    abstract::A wide range of support is available to help smokers to quit and to aid attempts at harm reduction, including three first-line smoking cessation medications: nicotine replacement therapy, varenicline and bupropion. Despite the efficacy of these, there is a continual need to diversify the range of medications so that t...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-016-0362-3

    authors: Beard E,Shahab L,Cummings DM,Michie S,West R

    更新日期:2016-10-01 00:00:00

  • Therapeutic monitoring of antiepileptic drugs during pregnancy and in the postpartum period: is it useful?

    abstract::As in all patient populations, epilepsy is common in pregnant women. Consequently, approximately 1 in 200 pregnancies is exposed to antiepileptic drugs (AEDs). Although exposure to AEDs in utero has been associated with an increased risk of major fetal malformations, most women with epilepsy require medication through...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/00023210-200620100-00001

    authors: Adab N

    更新日期:2006-01-01 00:00:00

  • Spotlight on risperidone in irritability associated with autistic disorder in children and adolescents.

    abstract::Risperidone (Risperdal), a psychotropic atypical antipsychotic agent, is thought to act via dopamine D(2) and serotonin 5-HT(2A) receptor antagonism. The clinical efficacy of oral risperidone in the treatment of bipolar mania and schizophrenia in adult patients is well established. In the US, risperidone is also appro...

    journal_title:CNS drugs

    pub_type: 评论,杂志文章

    doi:10.2165/00023210-200822030-00006

    authors: Scott LJ,Dhillon S

    更新日期:2008-01-01 00:00:00

  • Treatment Strategies for Dravet Syndrome.

    abstract::Dravet syndrome (DS) is a medically refractory epilepsy that onsets in the first year of life with prolonged seizures, often triggered by fever. Over time, patients develop other seizure types (myoclonic, atypical absences, drops), intellectual disability, crouch gait and other co-morbidities (sleep problems, autonomi...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-018-0511-y

    authors: Knupp KG,Wirrell EC

    更新日期:2018-04-01 00:00:00

  • Female hypoactive sexual desire disorder: epidemiology, diagnosis and treatment.

    abstract::Female hypoactive sexual desire disorder (HSDD) may occur in up to one-third of adult women in the US. The essential feature of female HSDD is a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty. The evaluation of female HSDD generally requ...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/00023210-200216110-00003

    authors: Warnock JJ

    更新日期:2002-01-01 00:00:00

  • Prospects for improving brain function in individuals with Down syndrome.

    abstract::Down syndrome (DS), which results from an extra copy of chromosome 21 (trisomy 21), is the most common genetically defined cause of intellectual disability. Although no pharmacotherapy aimed at counteracting the cognitive and adaptive deficits associated with this genetic disorder has been approved at present, there h...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-013-0089-3

    authors: Costa AC,Scott-McKean JJ

    更新日期:2013-09-01 00:00:00

  • Acetyl-L-carnitine in HIV-associated antiretroviral toxic neuropathy.

    abstract::Nucleoside analogue reverse transcriptase inhibitors (NRTIs), used as part of highly active antiretroviral therapy for the treatment of HIV and AIDS, disrupt neuronal mitochondrial DNA synthesis, resulting in antiretroviral toxic neuropathy (ATN). Acetyl-L-carnitine (ALC) enhances neurotrophic support of sensory neuro...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/00023210-200721001-00004

    authors: Youle M

    更新日期:2007-01-01 00:00:00

  • Evaluation of serum levels of chemokines during interferon-β treatment in multiple sclerosis patients: a 1-year, observational cohort study.

    abstract:BACKGROUND:The molecules that provide access to activated T cells in the CNS, including chemokines, have been considered to be a crucial step in the pathogenesis of multiple sclerosis (MS). AIMS:In this study, we investigated serial serum chemokine levels in patients with relapsing-remitting MS over 1 year and the ass...

    journal_title:CNS drugs

    pub_type: 杂志文章

    doi:10.2165/11595060-000000000-00000

    authors: Comini-Frota ER,Teixeira AL,Angelo JP,Andrade MV,Brum DG,Kaimen-Maciel DR,Foss NT,Donadi EA

    更新日期:2011-11-01 00:00:00

  • Hypnosedative-induced complex behaviours : incidence, mechanisms and management.

    abstract::A number of news items and case reports describing complex behaviours (e.g. sleep driving, sleep cooking, sleep eating, sleep conversations, sleep sex) associated with the use of hypnosedative medications have recently received considerable attention. Regulatory agencies examining these reports have subsequently issue...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/0023210-200822120-00005

    authors: Dolder CR,Nelson MH

    更新日期:2008-01-01 00:00:00

  • Seizures in HIV-seropositive individuals: epidemiology and treatment.

    abstract::Seizures are a relatively common occurrence in patients with HIV infection. They may be a result of HIV infection of the CNS or a manifestation of an opportunistic infection. Because seizures are likely to recur in patients infected with HIV and because they are a poor prognostic indicator, it is generally recommended...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/00023210-200216020-00002

    authors: Romanelli F,Ryan M

    更新日期:2002-01-01 00:00:00

  • Tianeptine: a review of its use in depressive disorders.

    abstract:UNLABELLED:Tianeptine is an antidepressant agent with a novel neurochemical profile. It increases serotonin (5-hydroxytryptamine; 5-HT) uptake in the brain (in contrast with most antidepressant agents) and reduces stress-induced atrophy of neuronal dendrites. Like the selective serotonin reuptake inhibitors (SSRIs) and...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/00023210-200115030-00006

    authors: Wagstaff AJ,Ormrod D,Spencer CM

    更新日期:2001-01-01 00:00:00

  • Adjunctive Cannabidiol in Patients with Dravet Syndrome: A Systematic Review and Meta-Analysis of Efficacy and Safety.

    abstract:BACKGROUND:Dravet syndrome (DS) is one of the most severe forms of drug-resistant epilepsy and available interventions fail to control seizures in most patients. Cannabidiol (CBD) is the first in a new class of antiepileptic drugs with a distinctive chemical structure and mechanism of action. OBJECTIVE:The aim of this...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-020-00708-6

    authors: Lattanzi S,Brigo F,Trinka E,Zaccara G,Striano P,Del Giovane C,Silvestrini M

    更新日期:2020-03-01 00:00:00

  • Methylene Blue in the Treatment of Neuropsychiatric Disorders.

    abstract::Methylene blue is a long-established drug with complex pharmacology and multiple clinical indications. Its diverse mechanisms of action are most likely responsible for the large variety of its clinical effects. Of interest to psychiatrists, methylene blue has antidepressant, anxiolytic, and neuroprotective properties ...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-019-00641-3

    authors: Alda M

    更新日期:2019-08-01 00:00:00

  • The Female Sexual Response: Current Models, Neurobiological Underpinnings and Agents Currently Approved or Under Investigation for the Treatment of Hypoactive Sexual Desire Disorder.

    abstract::How a woman responds to sexual cues is highly dependent on a number of distinct, yet related, factors. Researchers have attempted to explain the female sexual response for decades, but no single model reigns supreme. Proper female sexual function relies on the interplay of somatic, psychosocial and neurobiological fac...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-015-0288-1

    authors: Kingsberg SA,Clayton AH,Pfaus JG

    更新日期:2015-11-01 00:00:00

  • Pharmacological interventions for the treatment of smokeless tobacco use.

    abstract::Smokeless tobacco (SLT) is used in a variety of forms throughout the world. Long-term SLT use is associated with adverse health consequences. Effective pharmacotherapies are needed to treat SLT users who want to achieve tobacco abstinence. In the current review, we discuss the pharmacological interventions identified ...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/11598450-000000000-00000

    authors: Ebbert JO,Fagerstrom K

    更新日期:2012-01-01 00:00:00

  • Revisiting Tramadol: A Multi-Modal Agent for Pain Management.

    abstract::Tramadol-an atypical opioid analgesic-has a unique pharmacokinetic and pharmacodynamic profile, with opioidergic, noradrenergic, and serotonergic actions. Tramadol has long been used as a well-tolerated alternative to other drugs in moderate pain because of its opioidergic and monoaminergic activities. However, cumula...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-019-00623-5

    authors: Barakat A

    更新日期:2019-05-01 00:00:00

  • Diroximel Fumarate Demonstrates an Improved Gastrointestinal Tolerability Profile Compared with Dimethyl Fumarate in Patients with Relapsing-Remitting Multiple Sclerosis: Results from the Randomized, Double-Blind, Phase III EVOLVE-MS-2 Study.

    abstract:BACKGROUND:Diroximel fumarate (DRF) is a novel oral fumarate approved in the USA for relapsing forms of multiple sclerosis. DRF is converted to monomethyl fumarate, the pharmacologically active metabolite of dimethyl fumarate (DMF). DRF 462 mg and DMF 240 mg produce bioequivalent exposure of monomethyl fumarate and are...

    journal_title:CNS drugs

    pub_type: 杂志文章

    doi:10.1007/s40263-020-00700-0

    authors: Naismith RT,Wundes A,Ziemssen T,Jasinska E,Freedman MS,Lembo AJ,Selmaj K,Bidollari I,Chen H,Hanna J,Leigh-Pemberton R,Lopez-Bresnahan M,Lyons J,Miller C,Rezendes D,Wolinsky JS,EVOLVE-MS-2 Study Group.

    更新日期:2020-02-01 00:00:00

  • Taming glutamate excitotoxicity: strategic pathway modulation for neuroprotection.

    abstract::Much work has been carried out in recent years showing that elevated glutamate levels in the extracellular environment of the central nervous system play a pivotal role in neurodegeneration in acute CNS injuries. With the elucidation of the mechanism governing glutamate excitotoxicity, researchers are devising therape...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-015-0225-3

    authors: Jia M,Njapo SA,Rastogi V,Hedna VS

    更新日期:2015-02-01 00:00:00

  • Pharmacological manipulation of kynurenic acid: potential in the treatment of psychiatric disorders.

    abstract::The kynurenine pathway constitutes the main route of tryptophan degradation and generates the production of several neuroactive compounds; quinolinic acid is an excitotoxic NMDA receptor agonist, 3-hydroxykynurenine is a free-radical generator and kynurenic acid (KYNA) is an antagonist at glutamate and nicotinic recep...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/00023210-200923020-00001

    authors: Erhardt S,Olsson SK,Engberg G

    更新日期:2009-01-01 00:00:00

  • Genetic Influence on Efficacy of Pharmacotherapy for Pediatric Attention-Deficit/Hyperactivity Disorder: Overview and Current Status of Research.

    abstract::Multiple stimulant and non-stimulant medications are approved for the treatment of attention-deficit/hyperactivity disorder (ADHD), one of the most prevalent childhood neurodevelopmental disorders. Choosing among the available agents and determining the most effective ADHD medication for a given child can be a time-co...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-020-00702-y

    authors: Elsayed NA,Yamamoto KM,Froehlich TE

    更新日期:2020-04-01 00:00:00

  • Maternal Anti-Fetal Brain IgG Autoantibodies and Autism Spectrum Disorder: Current Knowledge and its Implications for Potential Therapeutics.

    abstract::Several studies have found a correlation between the presence of circulating maternal autoantibodies and neuronal dysfunction in the neonate. Specifically, maternal anti-brain autoantibodies, which may access the fetal compartment during gestation, have been identified as one risk factor for developing autism spectrum...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-015-0279-2

    authors: Fox-Edmiston E,Van de Water J

    更新日期:2015-09-01 00:00:00

  • Efficacy of olanzapine and ziprasidone for the treatment of schizophrenia: a systematic review.

    abstract::It is difficult to determine the relative efficacy of atypical antipsychotics for the treatment of schizophrenia, based on the available literature. The purpose of this article is to review and compare the efficacy of two atypical antipsychotics: olanzapine and ziprasidone.This review focused on randomised trials in w...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/00023210-200519060-00003

    authors: Matza LS,Baker TM,Revicki DA

    更新日期:2005-01-01 00:00:00

  • Secondary Progressive Multiple Sclerosis: Definition and Measurement.

    abstract::Secondary progressive multiple sclerosis (SPMS) is diagnosed retrospectively and involves a clinical course characterized by a progressive accumulation of neurological disability, independent of relapses, following an initial relapsing-remitting (RR) phase. Our incomplete understanding of the pathological mechanisms u...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-016-0340-9

    authors: Plantone D,De Angelis F,Doshi A,Chataway J

    更新日期:2016-06-01 00:00:00

  • Activities of daily living in patients with dementia: clinical relevance, methods of assessment and effects of treatment.

    abstract::Disability, characterised by the loss of ability to perform activities of daily living (ADL), is a defining feature of dementia that results in growing caregiver burden and the eventual need for alternative care or nursing home placement. Functional decline in patients with dementia can also result from causes other t...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/00023210-200418130-00003

    authors: Desai AK,Grossberg GT,Sheth DN

    更新日期:2004-01-01 00:00:00

  • Granisetron adjunct to fluvoxamine for moderate to severe obsessive-compulsive disorder: a randomized, double-blind, placebo-controlled trial.

    abstract:BACKGROUND:Several small studies have shown beneficial effects of ondansetron, a serotonin 5-HT(3) receptor antagonist, in the treatment of obsessive-compulsive disorder (OCD). The efficacy of other 5-HT(3) receptor antagonists in patients with OCD is still unclear. Granisetron does not alter cytochrome P450 activity a...

    journal_title:CNS drugs

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.2165/11635850-000000000-00000

    authors: Askari N,Moin M,Sanati M,Tajdini M,Hosseini SM,Modabbernia A,Najand B,Salimi S,Tabrizi M,Ashrafi M,Hajiaghaee R,Akhondzadeh S

    更新日期:2012-10-01 00:00:00

  • Therapeutic options for treatment-resistant depression.

    abstract::Treatment-resistant depression (TRD) presents major challenges for both patients and clinicians. There is no universally accepted definition of TRD, but results from the US National Institute of Mental Health's (NIMH) STAR*D (Sequenced Treatment Alternatives to Relieve Depression) programme indicate that after the fai...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/11530280-000000000-00000

    authors: Shelton RC,Osuntokun O,Heinloth AN,Corya SA

    更新日期:2010-02-01 00:00:00

  • Novel GLP-1 (Glucagon-Like Peptide-1) Analogues and Insulin in the Treatment for Alzheimer's Disease and Other Neurodegenerative Diseases.

    abstract::The link between diabetes mellitus and Alzheimer's disease (AD) has been known for the last few decades. Since insulin and insulin receptors are known to be present in the brain, the downstream signalling as well as the effect of hyperinsulinemia have been extensively studied in both AD and Parkinson's disease. Glucag...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-015-0301-8

    authors: Calsolaro V,Edison P

    更新日期:2015-12-01 00:00:00

  • Achieving Smoking Cessation in Individuals with Schizophrenia: Special Considerations.

    abstract::Premature mortality due to cardiovascular disease in those with schizophrenia is the largest lifespan disparity in the US and is growing; adults in the US with schizophrenia die, on average, 28 years earlier than those in the general population. The rate of smoking prevalence among individuals with schizophrenia is es...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.1007/s40263-017-0438-8

    authors: Cather C,Pachas GN,Cieslak KM,Evins AE

    更新日期:2017-06-01 00:00:00

  • Topiramate: as monotherapy in newly diagnosed epilepsy.

    abstract::Topiramate is an antiepileptic drug that has a broad spectrum of antiseizure effects, which appear to be the result of several neurostabilising pharmacological mechanisms. These include blockade of ion channels, potentiation of GABA neuroinhibition and glutamate receptor antagonism at non-NMDA receptors, as well as mi...

    journal_title:CNS drugs

    pub_type: 杂志文章,评审

    doi:10.2165/00023210-200317130-00007

    authors: Waugh J,Goa KL

    更新日期:2003-01-01 00:00:00

  • Correction to: Propofol: A Review of its Role in Pediatric Anesthesia and Sedation.

    abstract::The original article can be found online. ...

    journal_title:CNS drugs

    pub_type: 杂志文章,已发布勘误

    doi:10.1007/s40263-018-0561-1

    authors: Chidambaran V,Costandi A,D'Mello A

    更新日期:2018-09-01 00:00:00