Anti-NMDA Receptor Encephalitis In China:Case Analysis And Literature Review

Objective:Since the antibody against the N-Methyl-D-Aspartate (NMDA) receptor was reported in2007, there have been an increasing number of medical doctors realizing the N-methyl-d-aspartate antibody encephalitis. Europea country and the United States have launched large-scale clinical observational studies. But since2010, the first case was reported in China, there has been no large-scale clinical study in China. We analysed the hospital patients and published literature to summarize the clinical manifestations, laboratory examination and prognosis of the anti-NMDA receptor encephalitis.Methods:This study included hospital patients in Second Affiliated Hospital of Zhejiang University from January2012to March2015. Gender, age, clinical manifestations, laboratory test results, treatment and prognostic information are collected. Meanwhile, we searched VIP, Articles, China National Knowledge and pubmed, Cochrane, Web of Science for literatures of Chinese patients for paper about anti-NMDA receptor encephalitis. We statisticed the characteristics of the patients in our hospital and clinical literature review, and analysis the factors that may affect clinical features and prognosis. Results:The anti-NMDA recetor encephalitis uesualy occurs in young women. About50%of patients have prodromal symptoms. Most people start with psychiatric symptoms (78%). About60%of patients have movement disorders or seizures. At38%of the patients will be autonomic instability. Laboratory test results lack specificity, cerebrospinal fluid pressure, nucleated cells, protein, sugar, and chloride are normal or mildly elevated in most patients. The majority (85%) patients show abnormal EEG. No more than50%patients have abnormal MRI signal, FLAIR sequence may have a higher positive rate. Most (79%) patients have the same antibody titers in cerebrospinal fluid and blood, about20%of patients have lower blood antibody titers, Patients with cerebrospinal fluid abnormalities have a higher risk of lower antibody titers in blood (p=0.021). About20%of patients have tumor, and there is a significant gender difference (p=0.04). Female predilecte teratoma, but lung cancer in men. Intravenous immunoglobulins (IVIG) together with steroids have better treatment effect than IVIG only (p<0.001). For patients with tumor, tumor removment is necessary. Hypoventilation is a key factor of prognosis (p=0.01).Conclusion:In this study, We analysed the hospital patients and published literature to summarize the clinical manifestations, laboratory examination and prognosis of the anti-NMDA receptor encephalitis, which provides reference for clinical practice.