| ObjectiveTo analyze the clinical data of anti-N-methyl-D-aspartate(NMDA)receptor encephalitis,anti-leucine-rich glioma-inactivated 1(LGI1)encephalitis,anti-?-aminobutyric acid-B(GABAB)receptor encephalitis.Compare the clinical differences of anti-NMDA receptor encephalitis between children and adults.Analyze clinical features of severe anti-NMDA receptor encephalitis.Through above all,we aimed to provide experience for clinical clinical practice.Materials and methods124 patients who were admitted to Qilu Hospital of Shandong University and diagnosed with autoimmune encephalitis from October 2014 to January 2019 were enrolled.The included subjects were divided into anti-NMDA receptor encephalitis group(hereinafter referred to as group N),anti-LGI1 encephalitis group(hereinafter referred to as group L),and anti-GABAB receptor encephalitis group(hereinafter referred to as group G).Collect clinical data to retrospectively analyze characteristics of the three groups.At the same time,patients with age?41 years old in group N were classified as N-children group,and patients with age>14 years old were classified as N-adults group.The clinical data of the two groups were compared and analyzed.Also,patients who were admitted to intensive care unit(ICU)in group N were classified as severe N group,and patients who were not admitted to ICU in group N were classified as non-severe N group.Results1.Demographic characteristics:Among 124 patients,group N patients accounted for 49.2%(61/124),group L patients accounted for 41.9%(52/124),group G patients accounted for 8.9%(11/124).The ratio of male to female in group N,group L and group G were 0.56:1(22:39),2.47:1(37:15),4.5:1(9:2).The age ranged from 10 months old to 78 years old.Children in group N accounted for 36.1%(22/61),the ratio of male to female was 0.57:1(8:14).Adults in group N accounted for 63.9%(39/61),the ratio of male to female was 0.56:1(14:25).2.Clinical features:?prodromal symptoms:There were 11 cases,3 cases and 1 case with fever in group N,group L and group G respectively.There were 13 cases,1 case and 1 case with headache in group N,group L and group G respectively.In group N,there was no statistically significant difference in fever[10.3%(4/39)?31.8%(7/22),x2=3.086,P=0.079]and headache[25.6%(10/39)?13.6%(3/22),?2=0.599,P=0.439]among N-adults group and N-children group.?first symptoms:Seizures,mental symptoms and cognitive disorders were 53.2%(66/124),23.4%(29/124),and 18.5%(23/124),respectively.Thirteen patients first visited the mental health center after onset,including 10,3,and 0 patients in group N,group L,and group G,respectively.There was no statistically significant difference of seizures[51.3%(20/39);68.2%(15/22),?2=1.643,P=0.2]and cognitive impairment[12.8%(5/39)4.6%(1/22),P>0.05]between N-adults group and N-children group.Compared with the N-children group,N-adults group was susceptible to psychiatric symptoms[51.3%(20/39),22.73%(5/22),?2=4.742,P=0.029]as the first symptom onset.? clinical manifestations:The proportion of manifestations were as follows:seizures accounting for 81.5%(101/124),mental behavior abnormalities for 54.0%(67/124),fever for 33.1%(41/124),sleep disorders for 39.5%(49/124),cognitive impairment for 36.3%(45/124),headache for 20.2%(25/124),dyskinesia for 21.0%(26/124),near memory impairment for 21.0%(26/124),disturbance of consciousness for 21.0%(26/124),language barrier for 13.7%(17/124).The above clinical manifestations of N-adults group and N-children group were similar(P>0.05).3.Blood examination:The incidence of hyponatremia in patients in group N,group L and group G were 4.9%(3/61),48.1%(25/52),0%(0/11),respectively and those with hypochloremia were 1.6%(1/61),34.6%(18/52),18.2%(2/11)respectively.Among 86 patients undergoing thyroid function and thyroid antibody test,25.6%(22/86)of patients with abnormal anti-thyroglobulin antibody,which was 7 patients,14 patients,and 1 patient in group N,group L and group G,respectively.24.4%(21/86)of patients with abnormal anti-thyroid peroxidase antibodies,which was 7 cases,13 cases and 1 case in group N,group L and group G,respectively.Platelet count[40.9%(9/22),15.4%(6/39),?2=4.942,P=0.026]in N-children group is more prone to abnormalities than N-adults group.4.Cerebrospinal fluid examination:There were 38.8%(47/121)of patients with elevated lymphocytes,35.5%(43/121)with lymphocyte response,37.2%(45/121)with increased protein,22.3%(27/121)with reduced chloride and 48.8%(59/121)with increased immunoglobulin.Chloride reduction in group L was 49.0%(24/49).Cerebrospinal fluid protein[41.0%(16/39),9.1%(2/22),x2=6.896,P=0.009]and immunoglobulin[71.8%(28/39),31.8%(7/22),x2=9.192,P=0.002]were abnormal increase in N-adults group than that in N-children group.5.Specific antibodies:Patients in group N were all tested for cerebrospinal fluid(CSF)anti-NMDA antibody and 65.4%(34/52)were positive for serum anti-NMDA antibody.In group L,84.4%(38/45)cases were positive for CSF LGI1 antibody and 98.0%(49/50)were positive for serum anti-LGI1 antibody.In group G,80%(8/10)cases were positive for CSF GABABR antibody and 100%(11/11)were positive for serum anti-GABABR antibody.The positive rate of anti-NMDAR antibody[60.6%(20/33),73.7%(14/19),?2=0.911,P=0.340]in N-adults group and N-children group showed no significant difference.6.Tumor screening:73.4%(91/124)of AE patients underwent serum tests of tumor marker and 80.7%(100/124)underwent tumor imaging screenings.Tumor evidence was found in 13%(13/100)cases.There were 7 cases showing teratoma in group N,1 case of left renal hamartoma,2 cases of enlarged mediastinal lymph nodes which were associated with neoplasm,and 3 cases of lung mass lesions in group G.7.Severe anti-NMDA receptor encephalitis:Patients in severe N group were more likely to be complicated with ovarian teratoma[40.0%(4/10),5.9%(3/51),?2=6.516,P = 0.011],elevated leukocyte[60.0%(6/10),16.3%(8/51),?2 =6.506,P = 0.011],elevated tumor markers[71.4%(5/10),14.8%(4/51),P=0.007]and elevated antithyroglobu]in antibody[80.0%(4/5),10.7%(3/28),P = 0.004].Conclusion1.The clinical manifestations of AE are diverse.When confronted with patients with acute or subacute onset with cognitive dysfunction,abnormal mental behavior,and epilepsy as the main clinical manifestations,neurologists should consider the possibility of autoimmune encephalitis.In patients with anti-NMDA receptor encephalitis,the clinical manifestations of adults and children are similar,but adults are more likely to have psychotic symptoms as the first performance than children.When AE patients,especially those with anti-NMDA receptor encephalitis,onset with psychiatric symptoms,they may visit a mental health center,and psychiatrists should pay attention to differential diagnosis.2.1n patients with anti-NMDA receptor encephalitis,children are more prone to platelet abnormalities than adults.Anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies can be detected in some AE patients and the specific mechanism still needs further research and discussion.3.The results of CSF in AE patients are mostly lymphocyte reaction and elevated immunoglobulin.Chloride reduction is seen in patients with anti-LGI1 encephalitis.In patients with anti-NMDA receptor encephalitis,CSF protein and immunoglobulin are more likely to occur in adults than that in children.4.In specific antibody detection,positive rate of serum antibody in patients with anti-LGI1 encephalitis and anti-GABAB receptor encephalitis are higher than that in CSF.Detection of serum and cerebrospinal fluid antibody simultaneously help increase positive rate.In patients undergoing CSF NMDAR antibody test,there is nosignificant difference in serum antibody positive rate between children and adults.5.Patients with severe anti-NMDAR encephalitis are more likely to have complication with teratoma,elevated blood leukocytes,elevated blood tumor markers,elevated antithyroglobulin antibodies than non-severe patients.It is worthy of attracting the attention of neurology,psychiatry,emergency department and critical medicine,so that patients can get early diagnosis and treatment,comprehensive management and better rehabilitation. |
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