Abstract
Autoimmune encephalitis (AE) has been described as a severe neurological complication of coronavirus disease 2019 (COVID-19). Following the adjustment of COVID-19 prevention strategies on December 7, 2022, the virus spread rapidly and extensively across China. This study aimed to explore the changing characteristics of AE pre- and post- COVID-19 epidemic in Guangxi, China. A total of 169 patients who were first diagnosed with AE and admitted to the First Affiliated Hospital of Guangxi Medical University from November 1, 2021 to December 31, 2023 were enrolled in this case-control study. Patients with the onset of AE before or after December 7, 2022, were respectively classified into the pre- and post- COVID-19 epidemic groups. There were 78 AE patients in the pre-COVID-19 epidemic group and 91 patients in the post-COVID-19 epidemic group. Compared to the AE patients pre-COVID-19 epidemic group, AE patients in the post-COVID-19 group had higher rates of abnormal movements (p = 0.013), autonomic dysfunction (p = 0.003), higher CASE scores (p = 0.041), and higher probabilities of complications such as pneumonia (p = 0.025) and other autoimmune diseases (p = 0.014). A higher proportion of AE patients in the post-COVID-19 pandemic period received rituximab treatment compared to those in the pre-COVID-19 (16.48% vs. 6.41%, p = 0.043). Among the AE patients infected with COVID-19, those who has a relapse of AE also had a higher risk of complications with tumors, autoimmune diseases, cranial magnetic resonance imaging (MRI) abnormalities, and higher baseline modified Rankin Scale (mRS) (median [IQR]:4[4,5] vs. 3[2.75,4.25], p = 0.029). AE patients in the post-COVID-19 epidemic group suffer from more severe clinical symptoms and higher rates of other immune diseases. Rituximab is commonly used in the post-COVID-19 epidemic period. Relapsed AE patients with COVID-19 had a higher risk of complications with tumors, autoimmune diseases, abnormal MRIs, and higher baseline mRS.