Analysis Of Clinical Manifestations And Comparison Of Therapeutic Methods For Anti-NMDA Receptor Encephalitis

Background and Objective:With increasing knowledge about anti-NMDA receptor(NMDAR)encephalitis,this disease is no longer considered as a rare immune disease,or just a paranoplastic syndrome,but a common type of non-viral encephalitis,where anti-NMDA antibodies are the cause.Its clinical manifestations vary,but always include classic symptoms involving eight aspects: abnormal mental and motor behavior,epilepsy,and difficulty in speech,autonomic nerve dysfunction and changes in cognition and consciousness.All of the symptoms are non-specific,it is very difficult or impossible to diagnose the disease just based on the sympatoms.However,the classic symptoms could hint the existence of the disease.Therefore,the first of aim of this study was to analyse the symptoms of NMDA encephalitis and find the main symptoms that were associated with the disease to increase clinician’s alertness.Although the disease is self-limited to some extent,its progression and deterioration are rapid.So,the selection of treatment methods for this disease is particularly important.Currently,immunotherapy is widely accepted,and first-line immunotherapy usually includes corticosteroids and intravenous immunoglobulin(IVIG)or plasma exchange(PE).Second-line immunotherapy treatment is only used when the first-line treatment fails to produce sufficient benefits,or when the disease worsens.The typical drugs used in the second-line immunotherapy treatment include rituximab,azathioprine,and mycophoranate.Surgerical removal of tumors such as teratoma in ovaries can also improve the symptoms in patients with anti-NMDA receptor encephalitis.The choice of treatment is related to treatment effects and long-term prognosis in the patients.In first-line immunotherapy,the choice of treatment based on corticosteroids is puzzling clinicians.Therefore,the second aim of this study was to compare the effects of corticosteroids alone(Group A),corticosteroids combined with intravenous immunoglobulin or plasma exchange without(Group B)and with an addition of second line drugs(Group C).Methods:A total of 104 patients with anti-NMDA receptor encephalitis hospitalized in the Jiangxi Provincial People’s Hospital,and the First and Second Affiliated Hospital of Nanchang University were included in this study and divided in 3 groups namely corticosteroids alone(Group A),corticosteroids combined with intravenous immunoglobulin or plasma exchange without(Group B)and with an addition of second line drugs(Group C).The clinical manifestation,and improved Ranking scores before and after treatment in the patients in three groups were statistically compared.Results:Among the 104 patients(n= 52,42,10 for Group A,B,and C,respectively)with anti-NMDA receptor encephalitis,79(76%)cases had abnormal mental behaviors,including 37(71%)in Group A,32(76%)in group B,and 10(100%)in group C,and58(56% of 104)had epileptic seizure,including 28(54%)in group A,27(64%)in group B,and 3(30%)in group C,as well as 29(28% of 104)cases had motor dysfunction,including 16(31%)in group A,11(26%)in group B,and 2(20%)in group C.In addition,memory impairments were found in 30(29% of 104)cases,including 14(27%)in group A,13(31%)in group B,and 3(30%)in group C,and speech disorders were found in 33(32% of 104)cases,including 19(37%)in group A,14(33%)in group B and 0(0%)in group C,as well as decreased consciousness was found in 45(43% of 104)cases,including 21(40%)in group A,20(48%)in group B,and 4(40%)in group C.Moreover,autonomic nervous dysfunction was found in 57(55% of 104)cases,including 29(56%)in group A,20(48%)in group B(48%),and8(80%)in group C(80%),and central hypoventilation was found in 16(15% of 104)cases,including 8(15%)in group A,8(19%)in group B,and 0(0%)in group C.The treatment effects of corticosteroids combined with intravenous immunoglobulin or plasma exchange without(Group B)and with an addition of second line drugs(Group C)were significantly better than those of corticosteroids alone(Group A)(P < 0.001),but there was no significant difference in the treatment effects between Groups B and C(P=0.538).Conclusions:The most common sympatom in anti-NMDA receptor encephalitis was abnormal mental behaviors,followed by epileptic seizure,autonomic nervous dysfunction and then decreased consciousness.Memory impairments,motor dysfunction and central hypoventilation also occurred,but less frequently.The therapeutic effects of corticosteroids combined with other treatments such as intravenous immunoglobulin or plasma exchange are better than corticosteroids alone.