Difference Analysis Of Clinical Features Between Anti-NMDAR Encephalitis And Other Autoimmune Encephalitis

The abstract includes the following parts:Background:Autoimmune encephalitis(AE)is characterized by a variety of different clinical manifestations caused by different neuronal antibodies,accounting for about 10-20% of encephalitis patients.Anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis is the most common type of AE.The existing diagnostic criteria for AE rely heavily on immunotherapy response and antibody detection,but most medical institutions in China have not yet developed neuron antibody detection technology,and testing through commercial institutions is expensive,which may delay patients’ treatment to a certain extent.Purpose: By investigating the characteristics of clinical symptoms,auxiliary examinations,and outcomes of AE,we try to find instructive clinical features,laboratory tests,neuroelectrophysiological and imaging indicators for the diagnosis of anti-N-methyl-D-Aspartate receptor(NMDAR)encephalitis and other kinds of autoimmune encephalitis.So as to provide a basis for clinicians to further understand AE,make an accurate diagnose timely,and treat the patients of AE standardizedly.Methods:A retrospective study was conducted on patients who were hospitalized in the Neurology Department of Shenzhen Second People’s Hospital during the continuous period from January 2016 to June 2021.We observe the clinical symptoms,examination results and outcomes of the enrolled patients.The enrolled patients were divided into anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis and other AEs(AEs other than NMDAR encephalitis),and the clinical characteristics of AEs were further understood by comparing the differences between the two groups.The patient’s outcome was observed by the following indicators: The recovery of neurological function was graded using the modified Rankin Scale(m RS)on the 90 th day and the 180 th day after the onset respectively;The patients were followed up with or without symptomatic seizures 1 year after the onset.Results:1,A total of 23 AE patients with positive anti-neuronal antibodies were included in the study.The age of onset ranged from 14 to 75 years old,with an average age of 39.1 years old and a median age of 34 years old.There were 9 males(39.1%)and 14 females(60.9%).Among them,there were 10 cases of anti-NMDAR encephalitis,accounting for 43.5% of the total enrollment.A total of 13 patients were in the other AE group.The gender composition of anti-NMDAR encephalitis and other AE patients was compared by chi-square test,p=0.772,the difference was not statistically significant.The rank sum test was used to compare the age of onset between the two groups,p = 0.024,and there was a statistical difference in the age of onset between the two groups.2,This study found that the clinical manifestations of AE patients vary widely.The most common symptoms are seizures and mental disorders(mental behavior abnormalities);other symptoms include memory loss,disturbance of consciousness,focal nerve dysfunction(involuntary movement),and autonomic dysfunction.etc.Some patients have prodromal symptoms of fever.Patients with anti-NMDAR encephalitis(43.5%)accounted for the largest proportion of AEs.Observation of head MRI results of patients with anti-NMDAR encephalitis and other AEs,abnormal head MRI changes were found in 5/10 cases of anti-NMDAR encephalitis and 5/13 cases of other kinds of AEs;Chi-square test analysis,p> 0.05,suggesting that there was no significant difference in the incidence of cranial imaging involvement between the two groups.3,Among the 23 patients,2patients refused immunotherapy,and the remaining 21 patients all received first-line immunotherapy.As of June 2022,23 patients were followed up by telephone or outpatient medical record system,and 2 cases were found to be complicated with ovarian teratoma,which was found in patients with anti-NMDAR encephalitis;1 case was complicated with lung cancer,and the other case was complicated with thymoma,both of which were seen in patients with anti-AMPAR encephalitis patient.Two patients died in the anti-NMDAR encephalitis group,while no deaths were observed in the other AE groups.The longest follow-up time of the enrolled patients was 46 months,and the shortest follow-up time was 12 months.Kaplan-Meier statistical analysis was used to analyze the overall survival rate,p=0.0977,and there was no statistical difference between these two groups.4,In terms of outcomes,2 patients died,1 patient was severely disabled(m RS=5 points),1 patient was moderately disabled(m RS=3 points),and the remaining 19 patients(82.6%)had good outcomes(m RS≤2points).The m RS of patients in the anti-NMDAR group and other AE groups was analyzed using the shift analysis statistical method,and it was found that: on the 90 th day after onset,patients with good outcomes in these groups accounted for 11/13 and6/10 respectively;on the 180 th day of onset,the ratio was 11/13,7/10 respectively;the outcome of other AE groups was slightly better than that of anti-NMDAR encephalitis group.Conclusions:1,This study found that the clinical manifestations of AE patients vary widely,and the most common symptoms are seizures and mental disorders(abnormal mental behavior).Patients with anti-NMDAR encephalitis(43.5%)accounted for the largest proportion of AEs.2,The comparison found that the anti-NMDAR encephalitis and other AE groups had statistical differences in the age of onset and the incidence of mental disorder symptoms;in terms of outcomes on the 90 th day and 180 th day after the onset,the other AE groups had better outcomes than those in the anti-NMDAR group.slightly better.There were no significant statistical differences between the two groups in terms of the proportion of seizures/focal neurological dysfunction/cognitive impairment symptoms,gender tendency,abnormal brain MRI lesions,and overall survival rate.3,Most AE patients respond well to immunotherapy,and early initiation of immunotherapy can help improve the prognosis,including good prognosis of m RS score and good seizure-free control.Central hypoventilation and diffuse slow wave changes in the EEG at the onset of the disease suggest a serious condition and a poor prognosis.