Relapses of Anti-NMDAR, Anti-GABABR and Anti-LGI1 Encephalitis: A Retrospective Cohort Study

Abstract

ObjectiveTo investigate the relapse rate and study the factors that may predict the subsequent relapse in anti-NMDAR, anti-GABABR and anti-LGI1 encephalitis in Northeast China.MethodsIn the retrospective cohort study, we consecutively enrolled patients with anti-N1MDAR, anti-GABABR and anti-LGI1 encephalitis between March 2015 and November 2021. The patients were followed up for at least 6 months. The outcome variable was a binary variable of relapse or not. Predictors of relapse were identified.ResultsA total of 100 patients were enrolled. Relapse occurred in 26 (26%) patients after a median follow-up of 18 months since the first event. The relapse rates of anti - NMDAR, anti - GABABR and anti - LGI1 encephalitis were 25%, 33.3%, and 28.6%, respectively. The multivariable analysis results suggested that immunotherapy delay at the acute phase was independently associated with an increased risk of relapse in total patients (HR = 2.447, 95% CI = 1.027 - 5.832; P = 0.043). Subgroup analysis results showed that antibody titer was associated with the likelihood of relapse in anti-LGI1 encephalitis. The higher the concentration, the more likely it was for patients to have relapse (p=0.019).ConclusionThe general relapse rate of anti-NMDAR, anti-GABABR and anti-LGI1 encephalitis was 26%. The risk of subsequent relapse was elevated in those with delayed immunotherapy in the first episode. In subgroup of anti-LGI1 encephalitis, higher antibody titer was the risk factors of relapse. Thus, timely and aggressive immunotherapy may be beneficial for patients to prevent subsequent relapse.

Recurrent anti-N-methyl-D-aspartate receptor encephalitis followed by anti-myelin oligodendrocyte glycoprotein encephalitis-a case report

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Glucocorticoid-dependent multiple sclerosis overlapping anti-NMDA receptor encephalitis: a case report and literature review update

“…This benefit, however, may last for only 1 month and be followed by new or enlarged lesions [ 11 ]. As for anti-NMDAR encephalitis, delayed immunotherapy and high antibody titer may be the recurrent factors for anti-NMDAR encephalitis, and glucocorticoids can inhibit its recurrence [ 12 , 13 ]. The recurrent MRI lesions of the left lateral ventricle and centrum ovale majus after prednisone were reduced to 15 mg/d.…”

Autoimmune encephalitis: Epidemiology, pathophysiology and clinical spectrum (part 2)

“…[4] Relapses were found to be more common in patients without a tumour, after delayed immunotherapy as well as high antibody titres. [26] While a large proportion of patients recovers completely, some long-term sequelae may occur. Seizures are very frequent in the acute phase of AE, but only ~3% of patients experienced persistent seizures and required ongoing anti-epileptic medications during long-term follow-up.…”