Validation of the NEOS score in Chinese patients with anti-NMDAR encephalitis

Peng, Yaguang; Dai, Fangyin; Liu, Lei; Chen, Weiqi; H, Yan; Liu, Aihua; Zhang, Xinghu; Wang, Xiaohui; He, Jianxing; Li, Yatong; Li, Chenxi; Chen, Liuxi; Zhao, Yan; Li, Lin; Ma, Qiuying; Wang, Jiawei

doi:10.1212/nxi.0000000000000860

Cited by 22 publications

(17 citation statements)

References 21 publications

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“…However, even being not statistically significant, we found that treatment delay could be an important 1-year outcome predicting factor. This result is consistent with those reported in 2 large series of NMDAR ( 8 , 10 ). Other studies also found that an early immunosuppressive treatment could prevent long-term cognitive deficits in anti-LGI-1 LE ( 22 , 23 ).…”

Section: Discussionsupporting

confidence: 93%

“…Early diagnosis is important and can be made prior to the Ab-test results as well as in the absence of positive autoimmune antibody detection ( 9 ). Specific tools have been developed to predict the 1-year outcome of patients presenting with NMDAR encephalitis ( 8 , 10 ), which allow specific therapeutic management with induction or escalation strategies. There is no validated tool to predict outcome in other Ab-mediated AE.…”

Section: Introductionmentioning

confidence: 99%

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Cerebrospinal Fluid IL-17A Could Predict Acute Disease Severity in Non-NMDA-Receptor Autoimmune Encephalitis

et al. 2021

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IntroductionMost of our knowledge into autoimmune encephalitis (AE) comes from N-Methyl-D-Aspartate Receptor (NMDAR) encephalitis. The concentrations of cytokines in cerebrospinal fluid (CSF) including IL-17A have been found to be increased and associated with poor outcome. However, data on the cytokine concentration in CSF and its correlation with outcome is lacking for other types of AE.ObjectiveTo report the concentrations of CSF sIL-2R, IL-6, IL-8, IL-10 and IL-17A and to correlate it with acute disease severity and the 1-year outcome in non-NMDAR AE.MethodsWe measured the CSF concentration of each cytokine in 20 AE patients, and compared IL-6 and IL-17A concentrations with 13 patients with CNS demyelinating diseases and 20 non-inflammatory controls. Patients were > 18yr and had at least 1-year clinical follow-up. Intracellular and NMDAR antibody (Ab) -mediated encephalitis were excluded. A mRS ≤ 2 was retained as a 1-year good outcome.ResultsThe IL-17A concentration in CSF was higher in AE patients than in both control groups (p<0.01). No difference was observed in CSF concentration of IL-6 between groups. At disease onset, a high CSF IL-17A concentration correlated with a high modified Rankin Scale (p<0.05), a high Clinical Assessment Scale for Autoimmune Encephalitis score (p<0.001) and ICU admission (p<0.01). There was no correlation between the concentration of all CSF cytokines and the 1-year clinical outcome.ConclusionOur results show that CSF IL-17A could be interesting to assess initial severity in non-NMDAR AE. Thus, CSF IL-17A could be an interesting therapeutic target and be useful to assess early selective immunosuppressive therapy.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Cerebrospinal Fluid IL-17A Could Predict Acute Disease Severity in Non-NMDA-Receptor Autoimmune Encephalitis

et al. 2021

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“…In the multivariate regression model assessing all clinical data obtained within 4 weeks of starting treatment, the predictive value of the NEOS score was validated in this prospective cohort, which provided another Class III evidence of using the NEOS score as a tool to predict 1-year functional status in patients with anti-NMDAR encephalitis 3 , 5 . It is of interest to notice that patients in the low-FT3 subgroup had higher NEOS scores, which might provide a clue to predict the NEOS score in the early stage of the disease.…”

Section: Discussionmentioning

confidence: 91%

“…Each of them was assigned 1 point to create the NEOS score, which was strongly associated with the probability of poor functional status at 1 year 4 . It seemed to be a reliable tool to predict the 1-year outcome and was recently validated by another team in Chinese population 5 . However, some of the variables may not be obtained until 4 weeks of starting treatment, which in some extent limit its use in the early stage of the disease.…”

Section: Introductionmentioning

confidence: 99%

Emerging role of free triiodothyronine in patients with anti-N-methyl-D-aspartate receptor encephalitis

Huang

Lian

et al. 2021

Sci Rep

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We aimed to investigate the role of free triiodothyronine (FT3) in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. 137 consecutive inpatients (2016–2019) were registered prospectively and followed up for 12 months. 96 eligible patients were included in the study. The modified Rankin scale (mRS) score was collected, and the score of 3–6 was defined as a poor outcome. The patients were equally classified into 3 subgroups based on their FT3 levels obtained within 24 h of admission, and the subgroup differences were analyzed by parametric or nonparametric tests as appropriate. Logistic regression analysis was performed. We found that there was no difference in the mRS scores upon admission among 3 subgroups, however, patients in the low-FT3 subgroup tended to have higher disease severity during hospitalization and worse outcome in follow-up visits, represented by higher chances of intense care unit (ICU) admission (P < 0.001), longer hospital stay (P < 0.001), greater maximum mRS scores during hospitalization (P = 0.011), lower rates of getting clinical improvement within 4 weeks of starting treatment (P = 0.006), and higher percentages of poor 1-year outcome (P = 0.002). The level of FT3 was an independent factor correlated with ICU admission (P = 0.002) and might be a potential predictor for 1-year outcome. Our preliminary results suggest that the FT3 may be a risk factor involved in the evolution and progression of anti-NMDAR encephalitis, whereas the underline mechanisms remain to be explored. Attention should be paid to these patients with relatively low FT3 upon admission, which might possibly aid clinical prediction and guide clinical decision-making.

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“…However, 17% of the patients had relapses during the first 12 months, which is higher than previous studies (e.g., 12% over the first 2 years), and the frequency of tumors was lower (19.5%) than that previously reported (38%). In a separate study from China, Dr. Peng and colleagues 27 studied 111 patients with anti-NMDAR encephalitis and validated the anti-NMDAR encephalitis 1-year functional status (NEOS) score as a reliable predictor of poor functional status at 1-year follow-up.…”

mentioning

confidence: 99%