Current Progress on Assessing the Prognosis for Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis

Abstract

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most common antineuronal antibody encephalitis in autoimmune encephalitis found at present. It has complex clinical manifestations such as psychiatric and behavioral abnormalities, seizures, movement disorders, consciousness, and autonomic dysfunction. The relationship between those manifestations and prognosis is unclear. Electroencephalography (EEG) is gradually becoming useful in the evaluation of the prognosis of anti-NMDAR encephalitis patients, while imaging and antibody testing have a limited prognostic value. Starting the patients on adequate treatments (such as immunotherapy) in a timely fashion has a positive impact on their prognosis. Nevertheless, research on the prognosis of anti-NMDAR encephalitis remains scarce. Here, we review the current advances of prognosis-related research from the clinical manifestations of the disease and auxiliary examinations such as EEG, magnetic resonance imaging (MRI), 18F fluorodeoxyglucose positron emission tomography (FDG-PET), and antibody measurement. In addition, we also discuss the impact of different treatment options on prognosis. In-depth research on the prognosis of patients with anti-NMDAR encephalitis will contribute to a better understanding of this disease, leading to better treatments options and, ultimately, a better prognosis.

Neuronal Surface Antibody-Medicated Autoimmune Encephalitis (Limbic Encephalitis) in China: A Multiple-Center, Retrospective Study

“…However, only 8.39% of the patients in our cohort had a tumor, with ovarian teratoma comprising 84.2% of the tumors diagnosed in females. Other studies of Chinese or Asian cohorts have also reported a relatively low prevalence of tumors ( Supplementary Table 4 ) [Lim et al ( 24 ), 22.7%; Wang et al ( 25 ), 8%; Liu et al ( 22 ), 6.7%; Zhang et al ( 26 ), 8.1%]. The heterogeneity among Asian and Western populations might be due to different genetic backgrounds and epidemiologic factors.…”

Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis

“…18 F-FDG PET has also been shown to be superior to morphological imaging in the early diagnosis of autoimmune encephalitis 15 . The increasing number of publications studying the results of brain 18 F-FDG PET in autoimmune encephalitis over the past decade is in dire need of consolidation [13][14][15][16][17][18][19][20][21][22][23][24] . The literature is saturated with isolated case-reports and retrospective studies conducted on a small number of patients, leaving the role of PET in the initial assessment of the disease unclear.…”

Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Decrease in Blood Flow in Cerebellum

“…The second clinical implication in this case is that her symptoms improved after oral administration of MTX. At the acute stage, she was treated with first-line (glucocorticoid, IVIG, and PE) and second-line treatments (cyclophosphamide) for anti-NMDAR encephalitis [ 9 , 10 , 11 ]. However, because she did not respond to these treatments and anti-NMDAR antibodies in CSF remained positive, we started oral administration of MTX.…”