Prognosis analysis of 51 cases with anti-N-methyl-D-aspatate receptor encephalitis

Abstract

Objective To analyze the improvement of clinical symptoms, relapse and neurological functional recovery and the prognostic factors of anti-N-methyl-D-aspatate receptor (NMDAR) encephalitis. Methods Follow-up was conducted for 51 hospitalized patients with anti-NMDAR encephalitis at the Department of Neurology, Xuanwu Hospital, Capital Medical University from June 2012 to April 2015. The neurological functional recovery was evaluated through modified Ranking Scale (mRS), and the prognostic factors were analyzed. Results Among the 51 patients with anti-NMDAR encephalitis, 89%(45/51) were completely recovered or remained mild neurological dysfunction (mRS score≤2). The prognosis of main clinical symptoms was as follows: 78% (35/44) of the mental and behavior disorders were fully recovered, 94% (32/34) of the seizures were controlled and 65% (21/31) of the cognitive deficiency were completely recovered; 25% (13/51) of the patients relapsed. Comparison of clinical data of initial on-set among complete recovery patients group (mRS score=0), partial recovery patients group (mRS score=1 or 2) and poor prognosis patients group (mRS score≥3) showed that initial clinical manifestation with memory deficiency (17, 9, 6 cases respectively; χ2 =6.664, P=0.036), involuntary movements(19, 4, 5 cases respectively; χ2 =7.976, P=0.019) and central hypoventilation (5, 0, 2 cases respectively; χ2 =6.124, P=0.047) had statistically significant difference. Conclusions The majority of anti-NMDAR patients have favorable prognosis, but some of the patients may remain various degrees of neurological deficiency, including mental and behavior disorders, cognitive deficiency and seizures. Initial clinical manifestation with memory deficiency, involuntary movements and central hypoventilation may indicate a poorer prognosis. Key words: Encephalitis; Receptors, N-methyl-D-aspartate; Follow-up studies; Prognosis