Abstract
The clinical manifestations of patients with anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis in East China and factors associated with prognosis were analyzed. A retrospective study of 106 patients (58 females; 48 males) with anti-NMDAR encephalitis in East China was carried out from June 2015 to February 2019. Clinical features and factors influencing outcomes were reviewed. Behavioral changes were observed in 74.5% (79/106) of patients, and comprised the initial symptoms in 61.3% (65/106). Seizures were observed in 67% (71/106) of patients, and served as initial symptoms in 31.1% (33/106). A total of 54.9% (39/71) of seizures were focal seizures. More clinical symptoms were observed in female patients than in male patients (P = 0.000). Similarly, background activity (BA) with high cerebrospinal fluid (CSF) antibody titers at the peak stage was more severe in female patients than in male patients (P = 0.000). The Binary logistic regression and receiver operating characteristic (ROC) curve analyses revealed the factors associated with poor outcomes included consciousness disturbance (OR 4.907, 95% CI 1.653–14.562, P = 0.004; area: 65.4%, sensitivity: 44.2%, specificity: 86.5%, P = 0.014), EEG BA (OR 3.743, 95% CI 1.766–7.932, P = 0.001; area: 76.6%, sensitivity: 73%, specificity: 75%, P = 0.000), number of symptoms (OR 2.911, 95% CI 1.811–4.679, P = 0.000; area: 77.1%, sensitivity: 59.5%, specificity: 78.6%, P = 0.000) and CSF antibody titer (OR 31.778, 95% CI 8.891–113.57, P = 0.000; area: 83.9%, sensitivity: 89.2%, specificity: 78.6%, P = 0.000). EEG BA and number of symptoms were associated with CSF antibody titers. Consciousness disturbances, EEG BA, number of symptoms and CSF antibody titers served as predictors of poor outcomes.
Highlights
Anti-N-methyl-d-aspartate receptor encephalitis is an autoimmune disease associated with IgG antibodies against the NR1 subunit of the NMDA receptor[1,2]
We retrospectively identified 106 patients with anti-NMDAR encephalitis (58 females; 48 males)
High cerebrospinal fluid (CSF) antibody titers were observed in 60 patients with anti-NMDAR encephalitis and low CSF antibody titers in 37 patients
Summary
Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disease associated with IgG antibodies against the NR1 subunit of the NMDA receptor[1,2]. Normal brain MRI results have been observed in most patients[3,4,5]. Electroencephalography (EEG) may be useful for diagnosing anti-NMDAR e ncephalitis[6,7,8]. The number of clinical symptoms and electroencephalography (EEG) results were associated with cerebrospinal fluid (CSF) antibody titers[9]. No study has established whether EEG background activity (BA) during the peak stage of Scientific Reports | (2020) 10:10753. The purpose of our study is to provide a summary of the clinical features, and analyze the association between clinical features and prognosis in patients with anti-NMDAR encephalitis
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