J Clin Neurol.  2019 Jul;15(3):369-375. 10.3988/jcn.2019.15.3.369.

Factors Affecting the Response to First-Line Treatments in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis

• Zhang X
• Wang C
• Zhu W
• Wang B
• Liang H
• Guo S

• KMID: 2451122
• DOI: http://doi.org/10.3988/jcn.2019.15.3.369

Abstract

BACKGROUND AND PURPOSE
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune encephalitis. This study aimed to explore the possible factors affecting the response to first-line treatments in patients with anti-NMDAR encephalitis.
METHODS
We enrolled 29 patients who were diagnosed as anti-NMDAR encephalitis between January 1, 2015, and June 30, 2018. They were divided into the remission and nonremission groups according to their response to first-line treatments. The demographics, clinical manifestations, main ancillary examinations, follow-up treatments, and prognosis of patients were recorded. The symptoms reported on in this study occurred before treatments or during the course of first-line treatments.
RESULTS
There were 18 patients (62.07%) in the remission group and 11 patients (37.93%) in the nonremission group. Compared to the remission group, a higher proportion of the patients in the nonremission group exhibited involuntary movements, decreased consciousness, central hypoventilation, lung infection, and hypoalbuminemia. The nonremission group had a high incidence of increased intracranial pressure and significant elevations of the neutrophil-to-lymphocyte ratio in peripheral blood (NLR), aspartate aminotransferase, and fibrinogen. Six patients (54.55%) in the nonremission group received second-line immunotherapy. Only one patient (3.45%) died, which was due to multiple-organ failure.
CONCLUSIONS
Anti-NMDAR-encephalitis patients with more symptoms"”especially involuntary movements, disturbance of consciousness, central hypoventilation, and accompanying hypoalbuminemia and pulmonary infection"”may respond poorly to first-line treatments. Positive second-line immunotherapy therefore needs to be considered. Admission to an intensive-care unit, increased cerebrospinal fluid pressure, and increased NLR might be the significant factors affecting the response to first-line treatments.

Keyword

anti-N-methyl-D-aspartate receptor encephalitis; immunotherapy; response

MeSH Terms

Anti-N-Methyl-D-Aspartate Receptor Encephalitis*
Aspartate Aminotransferases
Cerebrospinal Fluid Pressure
Consciousness
Demography
Dyskinesias
Encephalitis
Fibrinogen
Follow-Up Studies
Humans
Hypoalbuminemia
Hypoventilation
Immunotherapy
Incidence
Intracranial Pressure
Lung
Prognosis
Aspartate Aminotransferases
Fibrinogen

Figure

• 

  Fig. 1 Differences in the NLR between the remission and nonremission groups. Data are mean and standard-deviation values. NLR: neutrophil-to-lymphocyte ratio in peripheral blood, p1: before the first-line treatments, p2: after the first-line treatments.

• 

  Fig. 2 Correlation between changes in albumin level and mRS scores. mRS: modified Rankin scale.

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