Elevated Plasma Homocysteine Levels in Anti-N-methyl-D-aspartate Receptor Encephalitis.

Lizhi Liu,Fuhua Peng,Zhigang Chen,Jie Liang,Chongliang Luo,Qing Liu,Rong Fan,Jia Liu,Ying Jiang,Yong Chen

doi:10.3389/fneur.2019.00464

Abstract

Objective: Homocysteine (Hcy) levels have been investigated in many diseases, such as neurodegenerative and autoimmune diseases. However, changes in Hcy levels in anti-N-Methyl-D-aspartate receptor (anti-NMDAR) encephalitis have not been investigated thus far.Methods: Case data were collected from 45 patients with anti-NMDAR encephalitis and 179 age- and sex-matched healthy controls (HCs). Clinical characteristics, Hcy levels, C reactive protein (CRP) levels, and cerebrospinal fluid (CSF) parameters were determined. Association of Hcy and clinical parameters were evaluated in these patients. Among these 45 patients, 15 had a follow-up evaluation at 3 months after treatment.Results: Hcy levels (p < 0.001) and CRP levels (p = 0.005) from the patients with anti-NMDAR encephalitis were significantly higher than those from HCs. Hcy levels from male patients were significantly lower than those from male HCs (p < 0.001). Comparing anti-NMDAR encephalitis patients after treatment with before treatment, the former has significantly higher Hcy levels (p = 0.004), CRP levels (p = 0.041) and mRS scores (p = 0.002). Furthermore, a significant negative correlation between the changes in Hcy levels and the changes in mRS scores (r = −0.534, p = 0.040) was observed.Conclusion: Elevated plasma homocysteine occurs in anti-NMDAR encephalitis, and seems associated with male sex.

Highlights

Anti-N-methyl-D-aspartate receptor encephalitis is the most common antibodymediated encephalitis [1], which commonly presents in young females of reproductive age and children, and can occur in males and females of all ages with or without tumors, such as ovarian teratomas [2,3,4]
The mean Homocysteine in Anti-NMDAR EncephalitisHomocysteine (Hcy) levels of anti-NMDAR encephalitis patients were significantly higher than the mean Hcy level of healthy controls (HCs) (p < 0.001; Table 1 and Figure 1A)
Patients with anti-NMDAR encephalitis were divided into different subgroups according to gender, age, modified Rankin Scale (mRS), disease duration, brain magnetic resonance imaging (MRI), presence of tumor and presence of seizure, and we investigated Hcy levels in different subgroups

Summary

Introduction

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common antibodymediated encephalitis [1], which commonly presents in young females of reproductive age and children, and can occur in males and females of all ages with or without tumors, such as ovarian teratomas [2,3,4]. This disorder, which represents severe neuropsychiatric manifestation characterized by seizures, memory decline, and behavioral deficits [5, 6], is caused by the production of autoantibodies against the GluN1 subunit of the NMDAR [7]. We for the first time set out to investigate the association between Hcy levels and clinical parameters in anti-NMDAR encephalitis

Methods

Results

Conclusion