Abnormal level of consciousness predicts outcomes of patients with anti-NMDA encephalitis

Aungsumart, Saharat; Ha, Atina; Apiwattanakul, Metha

doi:10.1016/j.jocn.2018.11.033

Cited by 20 publications

(16 citation statements)

References 14 publications

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“…Previous studies have shown that disturbance of consciousness at admission (GCS score ≤8 points) can be used as a predictor of death and is an independent risk factor for a poor prognosis. 8,10,21 In the present study, we found that the prognosis of patients with disturbance of consciousness at admission was even worse, which is consistent with previous studies. Disturbance of conscious-…”

Section: Jcn Discussionsupporting

confidence: 93%

Analysis of Risk Factors for a Poor Prognosis in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Construction of a Prognostic Composite Score

Wang

Zhu

et al. 2020

J Clin Neurol

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Background and Purpose Anti- N -methyl-D-aspartate receptor (NMDAR) encephalitis is the most-common form of autoimmune encephalitis, but its early diagnosis is challenging. This study aimed to identify the risk factors for a poor prognosis in anti-NMDAR encephalitis and construct a prognostic composite score for obtaining earlier predictions of a poor prognosis. Methods We retrospectively analyzed the clinical data, laboratory indexes, imaging findings, and electroencephalogram (EEG) data of 60 patients with anti-NMDAR encephalitis. The modified Rankin Scale (mRS) scores of patients were collected when they were discharged from the hospital. The mRS scores were used to divide the patients into two groups, with mRS scores of 3–6 defined as a poor prognosis. Logistic regression analysis was used to analyze independent risk factors related to a poor prognosis. Results This study found that 23 (38.3%) and 37 (61.7%) patients had good and poor prognoses, respectively. Logistic regression analysis showed that age, disturbance of consciousness at admission, and ≥50% slow waves on the EEG were significantly associated with patient outcomes. An age, consciousness, and slow waves (ACS) composite score was constructed to predict the prognosis of patients with anti-NMDAR encephalitis at an early stage based on regression coefficients. Conclusions Age, disturbance of consciousness at admission, and ≥50% slow waves on the EEG were independent risk factors for a poor prognosis. The ACS prognostic composite score could play a role in facilitating early predictions of the prognosis of anti-NMDAR encephalitis.

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Section: Jcn Discussionsupporting

confidence: 93%

Analysis of Risk Factors for a Poor Prognosis in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Construction of a Prognostic Composite Score

Wang

Zhu

et al. 2020

J Clin Neurol

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“…Furthermore, consciousness disturbance was a factor associated with nonfavorable outcomes in this study (Table 2 and Fig. 5), which was similar to a previous study [20]. In previous studies, the predictors of good outcomes were early treatment and lack of ICU admission [4].…”

Section: Discussionsupporting

confidence: 89%

Clinical features and influencing prognostic factors in patients with anti-NMDAR encephalitis: a cohort follow-up study in Chinese patients

Wang

Miao

Shi

et al. 2019

Preprint

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Objectives The clinical manifestations of patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis in East China and factors associated with prognosis were analyzed.Methods A retrospective study of 106 patients (58 females; 48 males) with anti-NMDAR encephalitis in East China was carried out from June 2015 to February 2019. Clinical features and factors influencing outcomes were reviewed.Results Behavioral changes were observed in 74.5% (79/106) of patients, and comprised the initial symptoms in 61.3% (65/106). Seizures were observed in 67% (71/106) of patients, and served as initial symptoms in 31.1% (33/106). A total of 54.9% (39/71) of seizures were focal seizures. More clinical symptoms were observed in female patients than in male patients ( P =0.000). Similarly, background activity (BA) with cerebrospinal fluid (CSF) antibody titers at the peak stage was more severe in female patients than in male patients ( P = 0.000). The Binary logistic regression and ROC curve analyses revealed the factors associated with poor outcomes included consciousness disturbance (OR: 4.907, 95% CI: 1.653-14.562, P =0.004; area: 65.4%, sensitivity: 44.2%, specificity: 86.5%, P =0.014 ), EEG BA (OR: 3.743, 95% CI: 1.766-7.932, P =0.001; area: 76.6%, sensitivity: 73%, specificity: 75%, P =0.000), number of symptoms (OR: 2.911, 95% CI: 1.811-4.679, P =0.000; area: 77.1%, sensitivity: 59.5%, specificity: 78.6%, P =0.000) and CSF antibody titer (OR: 31.778, 95% CI: 8.891-113.57, P =0.000; area: 83.9%, sensitivity: 89.2%, specificity: 78.6%, P =0.000).Conclusions EEG BA and number of symptoms were associated with CSF antibody titers. Consciousness disturbances, EEG BA, number of symptoms and CSF antibody titers served as predictors of poor outcomes.

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“…Autonomic instability is present in 42% of patients with anti-NMDAR encephalitis, so insight into storming triggers can potentially help manage patients with these clinical features and better enable us to predict storming episodes. 12 Treating autonomic storms via therapies such as intrathecal baclofen can alleviate symptoms, but identifying and avoiding triggers, such as bladder distension, could also play a key role in management. 13 Autonomic storming also occurs in other neurologic conditions, such as traumatic brain injury (TBI), hypoxic brain injury, and intraparenchymal hemorrhage, so these findings could have implications beyond anti-NMDAR encephalitis.…”

Section: Discussionmentioning

confidence: 99%

Association of Autonomic Storming with Urinary Catheter Removal in NMDA Receptor Encephalitis: A Case Report

Neale

Nathan

Lee

et al. 2020

The Neurohospitalist

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We present a case of a 47-year-old female who presented with altered mental status and was found to have severe anti-NMDA receptor encephalitis. Her intensive care unit course was complicated by paroxysmal sympathetic storming. She also had urinary retention for which a catheter was placed early in her admission, but attempts at removal were associated with worsening storming. Her average Clinical Features Scale score was 5.9 when the catheter was not in place compared to 3.6 with the catheter in place. This is the first case report to our knowledge demonstrating an association between urinary catheter removal and autonomic storming in anti-NMDA receptor encephalitis.

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Abnormal level of consciousness predicts outcomes of patients with anti-NMDA encephalitis

Cited by 20 publications

References 14 publications

Analysis of Risk Factors for a Poor Prognosis in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Construction of a Prognostic Composite Score

Analysis of Risk Factors for a Poor Prognosis in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Construction of a Prognostic Composite Score

Clinical features and influencing prognostic factors in patients with anti-NMDAR encephalitis: a cohort follow-up study in Chinese patients

Association of Autonomic Storming with Urinary Catheter Removal in NMDA Receptor Encephalitis: A Case Report

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