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Erschienen in:
07.08.2023 | original article
Anti-N-methyl-D-aspartate receptor encephalitis in adults: a systematic review and analysis
verfasst von: Yam R. Giri, MBBS, Allison Parrill, MD, Sreedevi Damodar, MD, Joshua Fogel, PhD, Nisrin Ayed, MD, Muhammad Syed, MBBS DO, Ijendu Korie, MD, Sivaranjani Ayyanar, MBBS, Christopher Typhair, MD, Seema Hashmi, MD, Bom B. Giri, MBBS
Erschienen in: neuropsychiatrie | Ausgabe 2/2024
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Purpose
To analyze predictors of treatment outcome for anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in adults.
Methods
We performed a comprehensive literature search of PubMed, PsycInfo, and OVID. We included 424 patients from case reports and case series. Demographics, anti-NMDAR antibodies, prodromal and presenting symptoms, diagnostic workup, and treatment variables were recorded. Inferential analyses were performed in the subset (n = 299) of those with known treatment outcomes. Multivariate multinomial logistic regression analysis for treatment outcome compared full recovery versus partial recovery and full recovery versus death.
Results
Treatment outcomes consisted of 34.67% full recovery (n = 147), 30.90% partial recovery (n = 131), 4.95% death (n = 21), and 29.48% unknown (n = 125). Speech/language abnormality and abnormal electroencephalogram (EEG) were each significantly associated with a higher relative risk for a full recovery. Treatment with intravenous immunoglobulin and plasmapheresis were each significantly associated with a higher relative risk for partial recovery. The analysis comparing death to full recovery found that catatonia was significantly associated with a lower relative risk for death. Increased age, orofacial dyskinesia, and no tumor removal were each significantly associated with a higher relative risk for death.
Conclusion
Increased age, orofacial dyskinesia, and no tumor removal were associated with a higher relative risk for death in anti-NMDAR encephalitis in adults. Clinicians should monitor and appropriately treat anti-NMDAR encephalitis with these findings to minimize the risk of death.
