Highlights
- •Altered mental status is a predictive factor for nonfavorable outcomes in anti-NMDA receptor encephalitis.
- •Patients with anti-NMDA encephalitis should be classified according to the clinical severity by conscious level for early and aggressive treatment.
- •CSF is more sensitive and specific for anti-NMDA detection.
Abstract
Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is an acute form of encephalitis with
an autoimmune etiology. We aimed to study clinical characteristics and treatment outcomes
and assess the predictive factors associated with patient outcome. In this retrospective
study, patients who presented with cardinal symptoms of anti-NMDA encephalitis and
positive anti-NMDA receptor antibody results in their cerebrospinal fluid were included
in the study. Thirty-one patients were identified. The median age of onset was 19 years
(IQR 15.0–31.0). Females were predominant (61.8%). The main clinical symptoms were
neuropsychiatric symptoms (87.1%) followed by abnormal movement (71%), seizures (51.1%),
and autonomic instability (41.9%). Eleven patients (35.5%) exhibited decreased levels
of consciousness. Abnormal MRI results were found in only 35.5% of the patients. CSF
abnormalities usually involved mild pleocytosis. Only 67.7% of serum samples were
positive against the anti-NMDAR antibody, whereas 100% of CSF samples were positive.
Tumor-related information was only available for 20 patients. Only one case involved
an ovarian teratoma. All patients received first-line therapy (intravenous pulse methylprednisolone
and plasmapheresis). Three patients were treated with second-line therapy (IV cyclophosphamide).
Twenty patients (64.5%) had favorable outcomes in our cohort (mRS 0–2) after a 1-year
follow-up. An abnormal level of consciousness was a factor associated with a nonfavorable
outcome (OR 15.65, 95% CI 2.30–106.29, p value <0.01).
Keywords
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Article info
Publication history
Published online: November 24, 2018
Accepted:
November 12,
2018
Received:
October 12,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
