Anti-N-methyl-D-aspartate receptor encephalitis with accompanying ovarian teratoma in female patients from East China: Clinical features, treatment, and prognostic outcomes

Lu, Zhigang; Lu, Yen‐Shen; Xu, Lan; Lü, Ling; Wu, Xunyi; Zhang, Youzhong; Zhu, Guangfa; Zhao, Hong

doi:10.1016/j.seizure.2019.12.016

Cited by 17 publications

(14 citation statements)

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“…The ONE-WC study was registered with the World Health Organization international clinical trial registry platform (registration number: ChiCTR1800019762) and was described in more detail in our previous publications. 11,[15][16][17] Briefly, the ONE-WC study consecutively enrolled patients with anti-NMDAR encephalitis from the Department of Neurology at West China Hospital beginning in October 2011 and collected prospective observational data (e.g., demographic information, clinical characteristics, treatment strategy, and functional outcomes). Participants in this study were recruited between October 2011 and September 2019.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Long-term Functional Outcomes and Relapse of Anti-NMDA Receptor Encephalitis

Gong

Chen

Liu

et al. 2021

Neurol Neuroimmunol Neuroinflamm

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ObjectiveTo study the factors associated with relapse and functional outcomes in patients with anti-NMDA receptor encephalitis in Western China.MethodsThe Outcome of the anti-NMDA receptor Encephalitis Study in Western China was initiated in October 2011 to collect prospective observational data from consecutively enrolled patients with anti-NMDA receptor encephalitis.ResultsWe consecutively enrolled 244 patients (median age: 26 years, range: 9–78 years; females: 128 [52.45%]) between October 2011 and September 2019. Fatality occurred in 17 (6.96%) patients, and tumors were found in 38 (15.57%) patients. The median follow-up duration was 40 (6–96) months. Of these patients, 84.8% showed clinical improvements within 4 weeks after immunotherapy, with a median modified Rankin Scale of 2 (interquartile range [IQR]: 2–3), and 80.7% (median: 1, IQR: 0–2) and 85.7% (median: 0, IQR: 0–1) had substantial recovery (i.e., mild or no residual symptoms) at 12 and 24 months, respectively. The overall prognosis was still improving at 42 months after onset. Disturbance of consciousness during the first month was the only independent predictor (OR: 2.91, 95% CI: 1.27–6.65; p = 0.01) of a poor functional neurologic outcome. Overall, 15.9% of the patients had one or multiple relapses, with 82.0% experiencing the first relapse within 24 months and 76.9% experiencing relapses that were less severe than the initial episodes. Relapse-related risk factors included the female sex and delayed treatment (p < 0.05).ConclusionsMost patients achieved favorable long-term functional outcomes. Some patients experienced one or multiple relapses, especially female patients. Timely immunotherapy at onset may reduce the risk of relapse.

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Section: Study Design and Participantsmentioning

confidence: 99%

Long-term Functional Outcomes and Relapse of Anti-NMDA Receptor Encephalitis

Gong

Chen

Liu

et al. 2021

Neurol Neuroimmunol Neuroinflamm

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“…The types of seizures are variable and patients may have generalized, partial, or mixed type seizures [ 16 ]. In the study by Zhang et al, who compared seizures in ANMDARE patients with and without teratomas, complex partial seizures were more common in the teratoma group [ 20 ]. There are no systematic reviews that include pooled data of EDB.…”

Section: Reviewmentioning

confidence: 99%

“…Schmit et al proposed that there is a disruption of the rhythmic neuronal activity in ANMDAR encephalitis. When antibodies block/target NMDAR, the rhythmic neuronal activity is disrupted which could lead to the unique EDB pattern [ 20 ].…”

Section: Reviewmentioning

confidence: 99%

“…The term EDB is derived from its resemblance to the delta brush pattern seen in premature infants, also known as beta-delta complexes [ 20 ]. The typical neonatal delta brushes are a combination of delta frequency transients with superimposed 8−20 Hz fast activity.…”

Section: Reviewmentioning

confidence: 99%

“…Neonatal delta brushes are usually symmetric but not synchronous and are seen less commonly in the frontal regions of the head. In contrast, the EDB pattern is often symmetric and synchronous and is typically seen broadly across all head regions [ 20 ]. Another theory proposed that delta activity is caused by focal abnormalities in the brain, and the superimposition of the beta waves is related to the alterations of the NMDA receptors [ 21 ].…”

Section: Reviewmentioning

confidence: 99%

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Understanding Seizures and Prognosis of the Extreme Delta Brush Pattern in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis: A Systematic Review

Parwani

Ortíz

Alli

et al. 2021

Cureus

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Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) is an autoimmune disorder with neurological and psychiatric features. The disease presents with a viral prodrome, followed by psychiatric manifestations. In the next phase, movement disorders or/and seizures occur. Finally, in the last phase, there is a decrease in the level of consciousness. Central hypoventilation and autonomic dysfunction can occur. Recently a unique EEG (electroencephalogram) pattern has been associated with anti-NMDA receptor encephalitis, the extreme delta brush (EDB). Although the association of the EDB with ANMDARE is known by the medical community, its significance is mainly unknown. A systematic review on NMDARE is also scarce. We decided to conduct a systematic review on this topic to consolidate the knowledge and establish the importance of the EDB as a prognostic factor. To conduct this systematic review, we used only studies conducted in humans, written in English, and published in the last 20 years. We used PubMed as a database and searched the following search terms: ("NMDA encephalitis"[Title/Abstract] AND "Epilepsy"[Title/Abstract]) OR (NMDA encephalitis"[Title/Abstract] AND "seizures" [Title/Abstract]) OR ("NMDA encephalitis"[Title/Abstract] AND "extreme delta brush"[Title/Abstract]). The protocol used for this systematic review was the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) protocol, and to analyze the bias of the studies, we used the ROBINS-1 tool. Eight studies were collected from our search strategy. Our data pulling showed that seizures were present in 178/249 (71.48%) patients. Status Epilepticus was reported in 29/96 (30.20%), and the EBD was seen in 30.89% (55/178) patients with seizures. The range of EDB was 5.9%-33% among the studies. Because the sample size was small, the statistical power was decreased. We had a low overall risk of bias. The wide range in the results could be related to the timing of the EEG recording. EDB was associated overall with increased length of hospital stay, increased ICU admission, and incidence of status epilepticus. The etiology of the EDB remains mainly unknown. However, it has been postulated that in NMDAR encephalitis, there is a disruption of the rhythmic neuronal activity. When antibodies block/target the NMDAR, the rhythmic neuronal activity is disrupted, leading to the unique EDB pattern. Another theory suggests that delta activity is caused because of focal abnormalities in the brain, and the superimposition of the beta waves is related to the alterations of the NMDA receptors.

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