A Clinical Study Of 32 Anti N-methyl-D-Aspartate Receptor Encephalitis Cases

Objective Up to now,there has been no large-scale clinical study related to anti-N-methylD-aspartate(NMDA)receptor encephalitis in China,and the clinical features of antiNMDA receptor encephalitis in Chinese are extremely lacking.In this study,we explored the characteristics of anti-NMDA receptor encephalitis in the population of Shandong Province by summarizing and analyzing the clinical data of 32 patients.This research can not only provide reference for clinical practice,but also lay the foundation for further clinical research.Methods This study retrospectively analyzed the general condition,clinical manifestations,auxiliary examinations,treatment and prognosis of 32 anti-NMDA receptor encephalitis patients,and discussed the factors related prognostic according to the quality of life in patients(MRS score)at the end of follow-up.Besides the patients were divided into minor group and adult group,and we compared the clinical data of two groups,then analyzed the different characteristics of different age groups.Results 1.Anti-NMDA receptor encephalitis often occurred in young and middle-aged patients(28 cases,88%)with a slightly higher incidence rate in female(18 cases,56%).53% of the patients(17 cases)had prodromic infection before the onset of disease.Initial symptoms showed psychiatric symptoms in 47% of the patients(15 cases),presented epilepsy in 28% of the patients(9 cases),presented other symptoms(such as cognitive disorders,movement disorders,hypersomnia,etc)in 25% of the patients(8 cases).The common neurological symptoms included psychiatric symptoms,seizures,decreased consciousness,movement disorders,cognitive disorders,speech distrubances,autonomic instability,hypoventilation,and so on.Routine examination and biochemical detection of cerebrospinal fluid(CSF),electroencephalogram(EEG),imaging analyses of patients were lack of specificity,and the detection of serum and CSF anti-NMDA receptor antibodies was helpful in the diagnosis of disease.22% of the patients(7 cases)suffered from tumors,3 cases of which(43%)underwent surgical treatment.94% of the patients(30 cases)had used first-line immunotherapy,17% of the patients(5 cases)had been given the second-line immunotherapy.72% of the patients(23 cases)had good outcome,9% of the patients(3 cases)were dead,and 12.5% of the patients(4 cases)had recurrence.The research also found that timely and effective immunotherapy can not only ameliorate the clinical symptoms in the short run,but also can improve the long-term prognosis.2.Comparing to the adult patients,the minor patients had a seasonal onset,they were more common to have their symptoms begun during April–September(p=0.028),also they were more likely to have prodromic infection(p=0.036).Likewise,the hospitalization time in minor group was significantly shorter than the adult group(p=0.009).The compositions of initial symptoms between the minor patients and the adult patients were not all the same(p=0.002).The former frequently presented epilepsy as primary symptom,the later lessly had epilepsy as first symptom.Adult patients were more likely to present decreased consciousness(p=0.028),cognitive impairment(p=0.005)and hypoventilation(p = 0.010)in the disease course.3.Analysis of the factors related to prognosis: one-factor analysis showed that age categories(the minor group and adult group,p=0.049),wheather or not suffering from decreased consciousness(p=0.015),hypoventilation(p=0.002),secondary infection(p=0.035)and the choice of immunotherapy(p=0.018)were associated with prognosis,and the different initial symptoms may be the related factors with prognosis.Multivariate logistic regression analyses revealed immunotherapy was a protective factor for anti NMDA receptor encephalitis and improved the prognosis(P = 0.030,or value = 0.003).Also the differences of the first symptoms may relate to the prognosis(p = 0.051).Conclusion Anti-NMDA receptor encephalitis varies widely in clinical manifestations.In different age groups,the characteristics of onset,clinical symptoms and prognosis are different.All confirmed cases are required to be screened for tumour,and the standard immunotherapy at an early stage was significant.The prognosis of patients is affected by various factors,such as age,clinical manifestations,treatment plans,etc.