Seizures And Risk Of Epilepsy And Short-term Prognosis In Anti-NMDAR And Anti-LGI1 Encephalitis:A Clinical Study

Background:Autoimmune encephalitis(AE)is the most common type of non-infectious encephalitis,which may be caused by abnormal autoimmune function,tumor or other cryptogenic causes.AE usually has an acute or subacute onset,and its clinical features include mental and behavioral abnormalities,autonomic disorders,consciousness disorder,dyskinesia,seizures and other neurological symptoms.Antigen-antibody reaction is happened to neuron self-antigens through antibodies in AE.Among all subtypes of AE,cell surface antigen antibody(CSAab)-related encephalitis accounts for a large part.In the acute stage of the disease,more than 50% of patients may have seizures,mental behavior changes,memory decrease and other symptoms of neurological defects.Objective:This study aims to retrospectively analysis the acute seizures and clinical features,risk of seizures and short-term prognosis in patients with N-methyl-D-aspartate receptor and Leucinie-rich gliomain activated 1 related encephalitis.Otherwise,providing reference for early clinical diagnosis and treatment.Methods:The patients with anti-NMDAR and anti-LGI1-related encephalitis who were admitted to the Department of Neurology of Sichuan Provincial People’s Hospital from January 2016 to December 2020 were continuously included.General information of the patients,clinical manifestations during hospitalization,types of acute seizure,taking antiepileptic drugs(AEDs)information,epileptic seizures and prognosis of patients after the acute phase were recorded and conduct a analysis to assess the risk factors of AE acute seizures,and the diffrences between the two types of AEs in the acute phase clinical in characteristics,seizure characteristics and short-term prognosis.Results:A total of 75 patients with anti-NMDAR and anti-LGI1 encephalitis were included,including 41 males and 34 females,with an average age of(32.8±17.9)years and an average course of disease in(1.8±1.1)months.Anti-LGI1 antibodies were positive in 16 cases,respectively,59 in anti-NMDAR.56 of 75 cases(74.7%)had seizure in acute phase.Among the 56 cases,38(67.8%)were accompanied by disturbances of consciousness,5 cases(8.9%)of autonomic dysfunction,and 24 cases(42.9%)of decreased oxygenation capacity and 20 cases(35.7%)who were admitted to NICU,there was a significant statistical difference compared with the seizure-free group(P<0.05).Dyskinesia,and abnormal EEG result are independent risk factors for anti-NMDAR and anti-LG1I-related encephalitis in the acute phase of seizures(P<0.05).The median age of anti-NMDAR encephalitis in the acute phase of seizure was 24 years,and that of anti-LGI1 encephalitis was 50 years(P<0.05).Anti-NMDAR encephalitis and anti-LGI1 encephalitis are common in the acute phase of epileptic seizures(55.9% vs.53.8%).Repetitive seizures and SE are more common in the acute phase of anti-NMDAR encephalitis(P< 0.05).After early rational use of AEDs and anti-immune treatments,70% of the 56 patients were effectively controlled for epilepsy at discharge.Follow-up 3 months later,18 patients(32.1%)stopped AEDs and 30(53.5%)patients Still receiving AEDs treatment,25 patients(44.6%)had no seizures.Conclusion: 1.Both anti-NMDAR encephalitis and anti-LGI1 encephalitis are at higher risk of seizures in the acute phase,patients with seizures are more likely to have disturbances in consciousness,decreased oxygenation capacity,and a higher proportion of admission to the NICU.Among them,dyskinesia and abnormal EEG results are independent risk factors for anti-NMDAR and anti-LG1 I encephalitis in acute seizures.2.Anti-NMDAR encephalitis is more common in young people around 30 years old,conversely,anti-LGI1 encephalitis is more likely to develop around 60 years old.3.Patients with anti-NMDAR encephalitis are more likely to have abnormal EEG results,longer average days in hospital,and are more likely to have repetitive seizures and status epilepticus in the acute phase.With timely diagnosis and intervention treatment,seizures are well controlled in most patients,about 1/3 of patients can withdraw AEDs after the acute phase.