Abstract
BackgroundPatients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis who also present with status epilepticus (SE) often have a poor prognosis. The aim of this study is to explore simple and effective predictors for anti-NMDAR encephalitis accompanied with SE.MethodsWe retrospectively analyzed 65 anti-NMDAR encephalitis patients from January 2015 to December 2018 who admitted to the Third Affiliated Hospital of Sun Yat-sen University. Patients were divided into SE group and non-SE groups. Their pre-treatment data and 3-month follow-up data were retrospectively analyzed.ResultsThe results showed that compared with the non-SE group, the levels of serum uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) in anti-NMDAR encephalitis patients with SE decreased significantly before treatment. Additionally, the levels of serum UA and HDL-C increased while the level of C-reactive protein (CRP) decreased 3 months after treatment in the SE group. Compared with the non-SE group, the SE patients had higher modified Rankin scale (mRS) scores before (mRS1) and after treatment (mRS2). Serum UA concentrations before treatment showed significantly negative correlations with mRS1 (r = − 0.407, p < 0.01) and mRS2 (r = − 0.458, p < 0.001), while the level of serum CRP before treatment had strong positive correlations with mRS1 (r = 0.304, p < 0.05) and mRS2 (r = 0.301, p < 0.05) in anti-NMDAR encephalitis patients. The receiver operating characteristic curve demonstrated that the combined detection of UA, HDL-C and CRP before treatment had a significantly higher value (the area under the curve = 0.848; 95% confidence interval [CI], 0.74–0.957; p < 0.001) to predict anti-NMDAR encephalitis accompanied with SE than that of single detection.ConclusionsHence, the combined detection of serum UA, HDL-C and CRP before treatment may be simple and effective indicators for predicting SE in anti-NMDAR encephalitis, which may be helpful in early stages to remind clinicians to be alert to the emergence of SE.
Highlights
Patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis who present with status epilepticus (SE) often have a poor prognosis
Baseline demographic and clinical characteristics of 65 participants Among 65 participants diagnosed with anti-NMDAR encephalitis enrolled in this study, 44 were Non-status epilepticus (non-SE) patients aged 29.45 ± 11.75 years (19 males and 25 females), and 21 were SE patients aged 26.48 ± 9.44 years
Our results demonstrate that high-density lipoprotein cholesterol (HDL-C) serum levels decrease in antiNMDAR encephalitis patients with SE when compared with the non-SE group, and they increase 3 months after treatment
Summary
Patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis who present with status epilepticus (SE) often have a poor prognosis. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, recognized by Dalmau et al in 2007, is a rare autoimmune disorder of central nervous system that is often misdiagnosed [1]. Liu et al BMC Neurology (2022) 22:27 anti-NMDAR encephalitis encompass prodromal symptoms, such as fever, flu-like illness or headaches from days to weeks before the onset, followed by neuropsychiatric changes, including memory deficits, coma, dyskinesia, seizures, and autonomic and language dysfunction [2]. It has been reported that 25% of anti-NMDAR encephalitis patients present with status epilepticus (SE) [2, 3]. Explorations in the potential diagnostic markers or therapies are meaningful for these patients in the clinical practice
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