Clinical Study On Anti-N-Methyl-D-Aspartate Receptor (Anti-Nmdar) Encephalitis In 19 Subjects Of Chongqing Region

Objective:The encephalitis associated with NMDAR-specific antibodies has been concerned recently. This disorderis characterized by CSF IgG antibodies against the NMDAR. The disease usually occurs in young adults and children, predominantly women, although it can affect patients of all ages. The purpose of this study is to improve the recognition and diagnosis of anti-NMDAR encephalitis and thus, clinicians could take rational treatment in time and improve patients’Prognosis.Methods:The clinical data of 19 patients with anti-NMDAR encephalitis were analyzed together with the clinical presentations, examination of cerebrospinal fluid, electroencephalogram, neuroimaging findings, diagnosis, treatment and prognosis. Reviewing literature and summarizing the clinical characteristic and the seizures characteristic of anti-NMDAR encephalitis.Results:Among the 19 patients with anti-NMDAR encephalitis,7 cases were male patients and 12 cases were female. The age range of 19 patients was 2-35 years old,15 cases were juvenile and 4 cases were adult.There were 16 cases with seizure,19 with psychological and behavioral abnormalities,18 with involuntary movement,19 with dyssomnia,10 with vegetative nerve dysfunction,4 with hypoventilation,9 with dyskinesia,19 with disturbance of consciousness,19 with poor eating.1 case with mediastinal mixed germ cell tumor,and lease with the thyroid gland fibroids.Among the 16 patients with seizure,13 cases were juvenile and 3 cases were adult.Among the 11 cases with seizure onset,5 were male patients and 6 were female.The type of seizure varied,including generalized tonic clonic seizure, partial seizure, clonic seizure, status epilepticus.The seizure can be controlled with immunosuppressant treatment.Outcome:1 was death,15 was discharged with a better health condition,3 was discharged with signature.Conclusion:The mainly clinical manifestation include psychological and behavioral abnormalities, seizure, dyssomnia, disturbance of cons-ciousness, involuntary movement, the recent memory loss, dyskinesia, vegetative nerve dysfunction and hypoventilation.The imaging manifesta-tions of anti-NMDAR encephalitis are not specific, some may involve the limbic system, e.g. temporal lobe, hippocampus, corpus callosum, insular lobe. The electroencephalogram (EEG) is almost always abnormal, showing focal or diffuse slow activity. NMDAR-specific antibodies can be found in CSF. Only the minority of patients had an underlying neoplasm. Sezure can occur in any stage, predominantly early stage. The patients respond to immunotherapy.