Clinical And Epilepsy Characteristics And Electroencephalogram Analysis Of 35 Cases Of Anti-N-methyl-D-aspartate Receptor Encephalitis

Objective: To analyze the clinical manifestations,seizure characteristics,electroencephalogram(EEG),imaging,cerebrospinal fluid characteristics(CSF)and treatment outcome of anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis.Method:The clinical data of 35 patients with anti-NMDAR encephalitis from 2014 to 2018 in Department of Neurology,Second Hospital of Hebei Medical University were retrospectively analyzed.Results:35 patients were 18 females,17 males,with a median age of 32 years(16-60),there are 23 young offenders,13 young women(72.3%)in women patients,10 cases(58.8%)in men patients.Of the 34 patients(1 female with automatic disease discharge who had not been screened for tumor screening),4 female had ovarian teratomas(both young)and 1 male had lung cancer(aged).All 35 patients were acute onset(study duration <3 months),and there were 21 cases(60%)with a history of pre-infection.11 cases(31.4%)had epilepsy as the first symptom,19 cases(54.3%)with mental behavior abnormality or cognitive impairment,and 5 cases(14.3%)with speech disorder as the first symptom.There were 21 cases(60%)in the whole course had seizures(17 cases of general tonic-clonic seizures,2 cases of partial motor seizures,1 case of sputum,1 case of partial motility secondary generalized seizures).There were 27 cases(77.1%)had abnormal mental behavior or cognitive impairment,9 cases(25.7%)with involuntary movement,11 cases(31.4%)with speech disorder,9 cases(25.7%)with autonomic dysfunction or central hypoventilation,and 20 cases with different degrees of consciousness.(57.1%).In 28 patients(except 6 patients without EEG and 1 patient with diffuse fast wave associated with sedatives),21 patients(75%)had abnormal EEG,there were local or extensive non-specific slow waves appeared.2 cases showed epileptic waves,and 1 case found specific extreme ? brush.In the 34 patients(except 1 patient who was discharged without imaging examination),17 patients had imaging abnormalities(50%),including 10 bilateral lesions(58.8%)and 7 unilateral lesions(41.2%).Of the patients with abnormal imaging findings,12 cases(70.6%)involved the frontotemporal lobe,9 cases(52.9%)involved the hippocampus,1 case(5.9%)involved the thalamus,2 cases(11.8%)involved the corpus callosum,and 1(5.9%)Involved in the parietal lobe.27 patients(8 patients in the cerebrospinal fluid test in the external hospital,due to the inability to trace specific test values and clear anti-NMDAR antibodies in serum or cerebrospinal fluid),15 patients(55.6%)with elevated cerebrospinal fluid and 22 patients with leukocytosis(81.5%),cytology is mainly lymphocyte reaction.8 patients(29.6%)had elevated lumbar puncture pressure(195-330 mmol/L).In 26 patients(96.3%),anti-NMDAR antibodies were present in cerebrospinal fluid,and 7(25.9%)anti-NMDAR antibodies were present in serum,of which 6(22.2%)antibodies were present in both serum and cerebrospinal fluid.A total of 32 patients(except for 2 patients who were untreated due to automatic discharge and 1 patient with mild symptoms)were treated with immunoglobulin and/or hormone therapy.According to the mRS score,these patients were divided into non-severe group(mRS ? 3 points)and severe group(mRS ? 4 points),17 patients in the non-severe group at admission,15 patients(88.2%)who were not serious at the time of discharge.2 people were severe(11.8%).At the time of admission,there were 15 patients in the severe group.The patients who were discharged from the hospital were 7 who were not serious(46.7%)and 8 who were serious(53.3%).A total of 5 patients were admitted to the intensive care unit,4 of whom were discharged automatically(mRS was 5),and 1 was converted to rehabilitation(mRS=4).Conclusion:1.The proportion of men and women in this group is quite similar.The disease occurs in young people,and young women are prone to ovarian teratoma.2.Seizures are the second most common first-episode symptom and the second most common clinical manifestation.Comprehensive tonic-clonic seizures are the most common form of seizures.3.EEG is a non-specific abnormality dominated by slow waves,but epilepsy wave and extreme delta brush are extremely rare.4.Half of the patients had imaging abnormalities.The most common affected area was the frontotemporal lobe,followed by the hippocampus..