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Grant support

Supported in part by Instituto Carlos III (FIS PI12/00611, F.G.; FIS 14/00203, J.D.; and CM14/00081, T.A.), NIH RO1NS077851 (J.D.), Fundacio Cellex (J.D.), Mutual Medica, and a grant from the Spanish Society of Pediatric Neurology (T.A.).

Analysis of institutional authors

Sanchez Del Valle Díaz, RaquelAuthorAguilar Creixenti, EstherAuthorCervera Alvarez , CarlosAuthorBosch Capdevila, BeatrizAuthorArmangue, TAuthorLlufriu, SAuthorRosenfeld, MAuthorGraus, FAuthorDalmau, JCorresponding Author

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November 6, 2015
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Autoimmune post-herpes simplex encephalitis of adults and teenagers

Publicated to:Neurology. 85 (20): 1736-1743 - 2015-11-17 85(20), DOI: 10.1212/WNL.0000000000002125

Authors: Armangue, T; Llufriu, S; Rosenfeld, M; Graus, F; Dalmau, J; Moris, G; Málaga, I; Cantarín-Extremera, V; González-Gutiérrez-Solana, L; Conde, CE; González, G; Rostasy, K; Erro, ME; Casado-Naranjo, I; Portilla-Cuenca, JC; Turón-Viñas, E; Muñoz-Cabello, B; Torres-Torres, C

Affiliations

), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S - Author
), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany - Author
), Hospital Universitario Central de Asturias, Oviedo - Author
), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia - Author
), Hospital Universitario Nino Jesus, Madrid, Spain - Author
Catalan Inst Res & Adv Studies ICREA, Barcelona, Spain - Author
Complejo Hosp Navarra, Dept Neurol, Pamplona, Spain - Author
G), Hospital Clinic, University of Barcelona - Author
Hosp Gen La Mancha Ctr, Dept Pediat Neurol, Alcazar De San Juan, Spain - Author
Hosp San Pedro de Alcantara, Dept Neurol, Caceres, Spain - Author
Hosp Santa Creu & Sant Pau, Pediat Neurol Unit, Barcelona, Spain - Author
Hosp Univ Cent Asturias, Dept Neurol, Oviedo, Spain - Author
Hosp Univ Cent Asturias, Pediat Neurol Unit, Dept Pediat, Oviedo, Spain - Author
Hosp Univ Hernando Moncaleano Perdomo, Dept Neurol, Neiva, Colombia - Author
Hosp Univ Nino Jesus, Dept Pediat Neurol, Madrid, Spain - Author
Hosp Univ Virgen del Rocio, Pediat Neurol Unit, Seville, Spain - Author
Univ Barcelona, Hosp Clin Barcelona, August Pi Sunyer Biomed Res Inst IDIBAPS, E-08007 Barcelona, Spain - Author
Univ Barcelona, Hosp Clin Barcelona, Dept Neurol, E-08007 Barcelona, Spain - Author
Univ Barcelona, Hosp Clin Barcelona, Neuroimmunol Program, E-08007 Barcelona, Spain - Author
Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA - Author
Univ Witten Herdecke, Childrens Hosp Datteln, Dept Pediat Neurol, Witten, Germany - Author
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Abstract

To report 14 patients with immune-mediated relapsing symptoms post-herpes simplex encephalitis (HSE) and to compare the clinical and immunologic features of the teenage and adult group with those of young children.Prospective observational study of patients diagnosed between June 2013 and February 2015. Immunologic techniques have been reported previously.Among the teenage and adult group (8 patients, median age 40 years, range 13-69; 5 male), 3 had an acute symptom presentation suggesting a viral relapse, and 5 a presentation contiguous with HSE suggesting a recrudescence of previous deficits. Seven patients developed severe psychiatric/behavioral symptoms disrupting all social interactions, and one refractory status epilepticus. Blepharospasm occurred in one patient. Five patients had CSF antibodies against NMDA receptor (NMDAR) and 3 against unknown neuronal cell surface proteins. In 5/6 patients, the brain MRI showed new areas of contrast enhancement that decreased after immunotherapy and clinical improvement. Immunotherapy was useful in 7/7 patients, sometimes with impressive recoveries, returning to their baseline HSE residual deficits. Compared with the 6 younger children (median age 13 months, range 6-20, all with NMDAR antibodies), the teenagers and adults were less likely to develop choreoathetosis (0/8 vs 6/6, p < 0.01) and decreased level of consciousness (2/8 vs 6/6, p < 0.01) and had longer delays in diagnosis and treatment (interval relapse/antibody testing 85 days, range 17-296, vs 4 days, range 0-33, p = 0.037).In teenagers and adults, the immune-mediated relapsing syndrome post-HSE is different from that known in young children as choreoathetosis post-HSE and is underrecognized. Prompt diagnosis is important because immunotherapy can be highly effective.© 2015 American Academy of Neurology.

Keywords

antibodiescase seriesmechanismsrelapsevirus encephalitisAdolescentAdultAgedD-aspartate receptorEncephalitis, herpes simplexFemaleHerpes simplexHumansImmunotherapyMaleMiddle agedProspective studiesSingle-blind methodYoung adult

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Neurology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2015, it was in position 8/193, thus managing to position itself as a Q1 (Primer Cuartil), in the category Clinical Neurology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 5.96. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 4.72 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 54.32 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-20, the following number of citations:

  • WoS: 202
  • Scopus: 153
  • Europe PMC: 122

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-20:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 214.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 218 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 19.95.
  • The number of mentions on the social network Facebook: 6 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 10 (Altmetric).
  • The number of mentions in news outlets: 1 (Altmetric).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Colombia; Germany; United States of America.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Armangué Salvador, Thais) and Last Author (Dalmau Obrador, Josep).

the author responsible for correspondence tasks has been Dalmau Obrador, Josep.