Infectious and Autoimmune Causes of Encephalitis

2020 webinar recording available to members

CME credit is no longer available.

In this webinar, primary care clinicians and pediatric specialists will learn to recognize the challenges that encephalitis presents and become familiar with approaches for unbiased diagnosis of infectious encephalitis and autoimmune antibody-mediated encephalitis. Dr. Wilson will speak about the Diagnosis of Infectious Encephalitis and Dr. Pleasure will talk about the diagnosis of Autoimmune Encephalitis.

Faculty:
Dr. Michael Wilson
University of California, San Francisco (UCSF)
Dr. Wilson has no conflicts of interest to disclose.

Dr. Sam Pleasure
University of California, San Francisco (UCSF)
Dr. Pleasure has no conflicts of interest to disclose.

Michael Wilson, MD is a Debbie and Andy Rachleff Distinguished Professor of Neurology and an Associate Professor in the UCSF Department of Neurology and Weill Institute of Neurosciences. He is a neurologist specializing in infectious and autoimmune diseases of the central nervous system. He sees patients with autoimmune diseases like multiple sclerosis as well as patients with a wide array of infectious diseases that impact the nervous system like HIV, neurocysticercosis, neurosyphilis, viral encephalitis and fungal infections like coccidiomycosis (valley fever). His laboratory uses metagenomic and immune repertoire sequencing techniques as well as phage display technologies to enhance understanding of the causes and immunopathogenesis of multiple sclerosis as well as autoimmune and infectious causes of meningoencephalitis.

Sam Pleasure, MD, PhD is the Glenn W. Johnson, Jr. Memorial Endowed Chair in Neurology at UCSF. Dr. Pleasure is a neurologist who specializes in caring for patients with multiple sclerosis. He also has expertise in caring for patients with epilepsy as well as years of experience in managing a variety of neurological conditions in both clinic and hospital settings. Dr. Pleasure has two main areas of inquiry for his research. He studies processes that regulate early brain development in both normal and diseased situations. He also studies autoimmune forms of meningoencephalitis, where inflammation in specific brain areas causes severe neurologic dysfunction. Pleasure received his medical degree and a doctorate in neuroscience from the University of Pennsylvania. He was chief resident during his neurology residency at UCSF, where he then completed a research fellowship in neuroscience Pleasure is a fellow of the American Neurological Association and a member of the American Academy of Neurology, American Epilepsy Society, Society for Neuroscience, Society for Developmental Biology and Cajal Club. He has won numerous awards for his research and has received research funding from a wide variety of private, state and federal sources. He has served in leadership roles in national organizations and in the UCSF Department of Neurology.

Copyright held by Foundation For Children With Neuroimmune Disorders

Contents: In this webinar, primary care clinicians and pediatric specialists will learn to recognize the challenges that that encephalitis represents as a public health concern, and become familiar with approaches for unbiased diagnosis of infectious encephalitis and autoimmune antibody-mediated encephalitis. Dr. Wilson will speak about the Diagnosis of Infectious Encephalitis and Dr. Pleasure will talk about the diagnosis of Autoimmune Encephalitis.

CME Planners:
Dr. P. Kory has no conflicts of interest to disclose.
Anna Conkey has no conflicts of interest to disclose.

Jointly Provided By
The Institute for Medical Studies

In Partnership With
Foundation For Children With Neuroimmune Disorders

Statement of Commercial Support
This activity has been produced with no commercial support

Terms of Offering
Date of release:
February 24, 2020

Date of expiration:
February 24, 2022 Requests for credit must be made no later than February 24, 2022.

Target Audience
The educational design of this activity addresses the needs of primary care clinicians and pediatric specialists including rheumatologists, neurologists, immunologists, infectious disease doctors, and psychiatrists.

Statement of Need/Program Overview
Autoimmune and Infectious Encephalitis are debilitating neurological disorders that often present with psychiatric symptoms and can involve in-patient hospitalization and substantial expenditures.  These disorders are increasing in incidence, possibly due to better diagnosis, but still remain challenging to diagnose. The existing paradigm for diagnosing infections relies on the physician formulating a differential diagnosis on the basis of a patient’s history, clinical presentation, and imaging findings, followed by serial laboratory testing. This traditional  approach is particularly challenging for neuroinflammatory diseases given overlapping clinical manifestations of infectious and noninfectious causes, a lack of diagnostic tests for rare pathogens, and the limited availability and volume of central nervous system (CNS) samples owing to the requirement for invasive procedures, such as lumbar puncture or brain biopsy. Thus, a cause for acute meningoencephalitis cases is not identified in approximately 50% of patients.  Failure to obtain a timely diagnosis in patients with CNS disease contributes to poor patient outcomes, increased patient and family anxiety, and a high cost burden.

Metagenomic next-generation sequencing (NGS) is a promising approach for the diagnosis of infectious disease because a comprehensive spectrum of potential causes — viral, bacterial, fungal, and parasitic – can be identified by a single assay. In cases where the cause is not infectious, newer techniques can help identify autoimmune causes in some case.

Primary care clinicians would benefit from education that raises their awareness of encephalitis, as well as an understanding of current and emerging new techniques for diagnosis. This online Clinical Comparison CME/CE activity allows learners to learn about the causes of encephalitis, drawbacks of traditional methods of diagnosis and the promise of newer diagnostic modalities.

Educational Objectives
After completing this activity, the participant should be better able to:

• Learn to recognize the problem that encephalitis represents as a public health concern
• Become familiar with approaches for unbiased diagnosis of infectious encephalitis.
• Become familiar with approaches for unbiased study of autoimmune antibody mediated encephalitis.

Physician Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The Institute for Medical Studies (IMS) and Foundation for Children With Neuroimmune Disorders. IMS is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation
IMS designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions to Receive Credit
This continuing medical education enduring material is in a video format. References are linked to online resources. In order to receive credit for this activity, the participant must view the video webinar in its entirety, and complete the post-test and evaluation. Upon completing this activity as designed and achieving a passing score on the post-test (80%), participants will submit their signed evaluation and registration form (linked) and will receive their CME certificates within 60 days.

List of references from the literature for future reading

• Exploratory analysis of the potential for advanced diagnostic testing to reduce healthcare expenditures of patients hospitalized with meningitis or encephalitis, Fulton BD et al PLoS One. 2020 Jan 15
• Clinical Metagenomic Sequencing for Diagnosis of Meningitis and Encephalitis, Wilson MR et al, N Engl J Med. 2019 Jun 13
• Pan-viral serology implicates enteroviruses in acute flaccid myelitis, Schubert RED et al, Nat Med. 2019 Nov
• Kelch-like Protein II Antibodies in Seminoma-Associated Paraneoplastic Encephalitis, Mandel-Brehm C et al, N Engl J Med. 2019