Anti-N-methyl-D-aspartate receptor encephalitis in adults: asystematic review and analysis.

Abstract

To analyze predictors of treatment outcome for anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in adults. We performed acomprehensive literature search of PubMed, PsycInfo, and OVID. We included 424patients from case reports and case series. Demographics, anti-NMDAR antibodies, prodromal and presenting symptoms, diagnostic workup, and treatment variables were recorded. Inferential analyses were performed in the subset (n = 299) of those with known treatment outcomes. Multivariate multinomial logistic regression analysis for treatment outcome compared full recovery versus partial recovery and full recovery versus death. Treatment outcomes consisted of 34.67% full recovery (n = 147), 30.90% partial recovery (n = 131), 4.95% death (n = 21), and 29.48% unknown (n = 125). Speech/language abnormality and abnormal electroencephalogram (EEG) were each significantly associated with ahigher relative risk for afull recovery. Treatment with intravenous immunoglobulin and plasmapheresis were each significantly associated with ahigher relative risk for partial recovery. The analysis comparing death to full recovery found that catatonia was significantly associated with alower relative risk for death. Increased age, orofacial dyskinesia, and no tumor removal were each significantly associated with ahigher relative risk for death. Increased age, orofacial dyskinesia, and no tumor removal were associated with ahigher relative risk for death in anti-NMDAR encephalitis in adults. Clinicians should monitor and appropriately treat anti-NMDAR encephalitis with these findings to minimize the risk of death.