Clinical Analysis Of Anti NMDA Receptor Encephalitis

Objective:N-methyl-D-aspartate(N-methyl-D-Aspartate,NMDA)receptor was discovered in 2007 and was first reported in 2011 in China.However,in China,the clinical features of anti NMDA receptor encephalitis have not been clearly recognized because of the lack of large and reliable clinical research.To understand the clinical features of anti NMDA receptor encephalitis in China is of great significance to the prevention and treatment of this disease.By summarizing the clinical features of 49 patients with anti NMDA receptor encephalitis in Tongji Hospital Affiliated to Huazhong University of Science and Technology,the clinical features of the disease were summed up in combination with the changes of imaging,electroencephalogram and cerebrospinal fluid,and the understanding and understanding of the disease were deepened.Methods:(1)age and sex characteristics: Anti NMDA receptor encephalitis is common in women,especially young women.(2)clinical features: 53% of the patients had prodrome.Among the first symptoms,mental disorders or cognitive impairment accounted for 53% and epilepsy accounted for 35%.Of the patients,78% of the patients had abnormal mental behavior or cognitive impairment,43% had speech disorders,69% had epileptic seizures,37% had dyskinesia / involuntary movement,49% had a decrease in consciousness,57% had autonomic nervous dysfunction or central hypoventilation.(3)auxiliary examination: the number of abnormal CSF cells accounted for 55%,protein abnormalities accounted for 22%,sugar abnormalities accounted for 10%,and chlorine abnormalities accounted for 14%.Abnormal EEG accounted for 55%,mostly local or diffuse slow wave and epileptiform discharges.Magnetic resonance imaging accounted for 75% of the abnormalities,mostly located in temporal lobe,insular lobe and hippocampus,and also in frontal lobe and occipital lobe.4% of the patients had tumors,including ovarian teratoma and pelvic mass.57% of the patients had double positive serum and cerebrospinal fluid antibodies,only 10% of the sera were positive,only 20% were positive for CSF antibody.(4)treatment: in first-line immunotherapy,94% of the patients were treated with glucocorticoid shock,51% of the patients were given intravenous immunoglobulin,and 12% of the patients received plasma exchange therapy.12% of the patients received two-line immunotherapy.(5)prognosis and follow-up: the average length of stay was 33.2 days,of which average ICU was 11.4 days.1 years later,the prognosis was good,accounting for 76%.18% of the patients relapsed,and 6% of the patients still had seizures.The first symptom was a better prognosis in patients with mental disorders or cognitive impairment than those with epilepsy(P=0.024).Conclusion:The anti NMDA receptor encephalitis in our country is mostly seen in young women.The first symptoms and clinical manifestations are the most common in mental and behavioral disorders or cognitive impairment.The first symptoms of mental and behavioral disorders or cognitive impairment are better than those in the epileptic patients.