Development of the clinical assessment scale in autoimmune encephalitis

Objective There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale. Methods The key items were generated by a...

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Published in:Annals of neurology Vol. 85; no. 3; pp. 352 - 358
Main Authors: Lim, Jung‐Ah, Lee, Soon‐Tae, Moon, Jangsup, Jun, Jin‐Sun, Kim, Tae‐Joon, Shin, Yong‐Won, Abdullah, Suhailah, Byun, Jung‐Ick, Sunwoo, Jun‐Sang, Kim, Keun Tae, Yang, Tae‐Won, Lee, Woo‐Jin, Moon, Hye‐Jin, Kim, Dong Wook, Lim, Byung Chan, Cho, Yong Won, Yang, Tae‐Ho, Kim, Hee Jin, Kim, Young‐Soo, Koo, Yong Seo, Park, Byeongsu, Jung, Keun‐Hwa, Kim, Manho, Park, Kyung‐Il, Jung, Ki‐Young, Chu, Kon, Lee, Sang Kun
Format: Journal Article
Language:English
Published: United States Wiley Subscription Services, Inc 01.03.2019
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ISSN:0364-5134, 1531-8249, 1531-8249
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Abstract Objective There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale. Methods The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38). Results A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92). Interpretation CASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352–358.
AbstractList There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale.OBJECTIVEThere is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale.The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38).METHODSThe key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38).A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92).RESULTSA new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92).CASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352-358.INTERPRETATIONCASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352-358.
There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale. The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38). A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92). CASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352-358.
Objective There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale. Methods The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38). Results A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92). Interpretation CASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352–358.
ObjectiveThere is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale.MethodsThe key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38).ResultsA new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92).InterpretationCASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352–358.
Author Lee, Woo‐Jin
Yang, Tae‐Ho
Kim, Tae‐Joon
Kim, Dong Wook
Byun, Jung‐Ick
Kim, Hee Jin
Park, Kyung‐Il
Kim, Keun Tae
Moon, Hye‐Jin
Jung, Ki‐Young
Lee, Sang Kun
Cho, Yong Won
Shin, Yong‐Won
Yang, Tae‐Won
Lee, Soon‐Tae
Koo, Yong Seo
Park, Byeongsu
Jun, Jin‐Sun
Moon, Jangsup
Kim, Young‐Soo
Lim, Jung‐Ah
Sunwoo, Jun‐Sang
Kim, Manho
Jung, Keun‐Hwa
Lim, Byung Chan
Abdullah, Suhailah
Chu, Kon
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  givenname: Jung‐Ah
  surname: Lim
  fullname: Lim, Jung‐Ah
  organization: Hallym University College of Medicine
– sequence: 2
  givenname: Soon‐Tae
  orcidid: 0000-0003-4767-7564
  surname: Lee
  fullname: Lee, Soon‐Tae
  organization: Seoul National University Hospital
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  givenname: Jangsup
  surname: Moon
  fullname: Moon, Jangsup
  organization: Seoul National University Hospital
– sequence: 4
  givenname: Jin‐Sun
  surname: Jun
  fullname: Jun, Jin‐Sun
  organization: Kyungpook National University, Kyungpook National University Chilgok Hospital
– sequence: 5
  givenname: Tae‐Joon
  surname: Kim
  fullname: Kim, Tae‐Joon
  organization: Ajou University School of Medicine, Ajou University Medical Center
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  fullname: Shin, Yong‐Won
  organization: Seoul National University Hospital
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  surname: Abdullah
  fullname: Abdullah, Suhailah
  organization: University Malaya Medical Center
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  givenname: Jung‐Ick
  surname: Byun
  fullname: Byun, Jung‐Ick
  organization: Kyung Hee University Hospital at Gangdong
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  givenname: Jun‐Sang
  surname: Sunwoo
  fullname: Sunwoo, Jun‐Sang
  organization: Soonchunhyang University School of Medicine
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  givenname: Keun Tae
  surname: Kim
  fullname: Kim, Keun Tae
  organization: Keimyung University Dongsan Medical Center, School of Medicine
– sequence: 11
  givenname: Tae‐Won
  orcidid: 0000-0002-8113-2384
  surname: Yang
  fullname: Yang, Tae‐Won
  organization: Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine
– sequence: 12
  givenname: Woo‐Jin
  surname: Lee
  fullname: Lee, Woo‐Jin
  organization: Seoul National University Hospital
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  givenname: Hye‐Jin
  surname: Moon
  fullname: Moon, Hye‐Jin
  organization: Soonchunhyang University Bucheon Hospital
– sequence: 14
  givenname: Dong Wook
  surname: Kim
  fullname: Kim, Dong Wook
  organization: Konkuk University School of Medicine
– sequence: 15
  givenname: Byung Chan
  surname: Lim
  fullname: Lim, Byung Chan
  organization: Seoul National University Children's Hospital
– sequence: 16
  givenname: Yong Won
  orcidid: 0000-0002-6127-1045
  surname: Cho
  fullname: Cho, Yong Won
  organization: Keimyung University Dongsan Medical Center, School of Medicine
– sequence: 17
  givenname: Tae‐Ho
  surname: Yang
  fullname: Yang, Tae‐Ho
  organization: Chonbuk National University Hospital
– sequence: 18
  givenname: Hee Jin
  surname: Kim
  fullname: Kim, Hee Jin
  organization: Samsung Medical Center
– sequence: 19
  givenname: Young‐Soo
  surname: Kim
  fullname: Kim, Young‐Soo
  organization: Gyeongsang National University Hospital, Gyeongsang National University College of Medicine
– sequence: 20
  givenname: Yong Seo
  surname: Koo
  fullname: Koo, Yong Seo
  organization: University of Ulsan College of Medicine
– sequence: 21
  givenname: Byeongsu
  surname: Park
  fullname: Park, Byeongsu
  organization: Ulsan University Hospital, Ulsan University College of Medicine
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  orcidid: 0000-0003-1433-8005
  surname: Jung
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  organization: Seoul National University Hospital
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  givenname: Manho
  surname: Kim
  fullname: Kim, Manho
  organization: Seoul National University College of Medicine
– sequence: 24
  givenname: Kyung‐Il
  surname: Park
  fullname: Park, Kyung‐Il
  organization: Seoul National University Hospital Healthcare System Gangnam Center
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  surname: Jung
  fullname: Jung, Ki‐Young
  organization: Seoul National University Hospital
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  givenname: Kon
  orcidid: 0000-0001-5863-0302
  surname: Chu
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  email: stemcell.snu@gmail.com
  organization: Seoul National University Hospital
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  givenname: Sang Kun
  surname: Lee
  fullname: Lee, Sang Kun
  email: sangkun2923@gmail.com
  organization: Seoul National University Hospital
BackLink https://www.ncbi.nlm.nih.gov/pubmed/30675918$$D View this record in MEDLINE/PubMed
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10.1056/NEJMra1708712
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Snippet Objective There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in...
There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients...
ObjectiveThere is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in...
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SubjectTerms Acceptability
Adolescent
Adult
Aged
Aggression - psychology
Anti-N-Methyl-D-Aspartate Receptor Encephalitis - complications
Anti-N-Methyl-D-Aspartate Receptor Encephalitis - physiopathology
Anti-N-Methyl-D-Aspartate Receptor Encephalitis - psychology
Ataxia
Ataxia - etiology
Ataxia - physiopathology
Autoimmune diseases
Autoimmune Diseases - complications
Autoimmune Diseases - physiopathology
Autoimmune Diseases - psychology
Autoimmune Diseases of the Nervous System - complications
Autoimmune Diseases of the Nervous System - physiopathology
Autoimmune Diseases of the Nervous System - psychology
Brain stem
Consistency
Correlation analysis
Correlation coefficient
Correlation coefficients
Delusions - psychology
Dyskinesia
Dyskinesias - etiology
Dyskinesias - physiopathology
Dystonia
Dystonia - etiology
Dystonia - physiopathology
Encephalitis
Encephalitis - complications
Encephalitis - physiopathology
Encephalitis - psychology
Encephalomyelitis, Acute Disseminated - complications
Encephalomyelitis, Acute Disseminated - physiopathology
Encephalomyelitis, Acute Disseminated - psychology
Female
Gait
Gait Disorders, Neurologic - etiology
Gait Disorders, Neurologic - physiopathology
Hallucinations - psychology
Humans
Language Disorders - etiology
Language Disorders - physiopathology
Limbic Encephalitis - complications
Limbic Encephalitis - physiopathology
Limbic Encephalitis - psychology
Male
Memory Disorders - etiology
Memory Disorders - physiopathology
Mental disorders
Middle Aged
Muscle Weakness - etiology
Muscle Weakness - physiopathology
Patients
Reliability
Reproducibility
Reproducibility of Results
Seizures - etiology
Seizures - physiopathology
Severity of Illness Index
Signs and symptoms
Stability
Validity
Young Adult
Title Development of the clinical assessment scale in autoimmune encephalitis
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