Clinical And EEG Characteristics Of 38 Patient With Neuronalsurface Antibody-associated Autoimmune Encephalitis

Objective:To explore the clinical characteristics of neuronal surface antibody-associated autoimmune encephalitis(AE)and to deepen clinicians’ cognize of this diseases.Methods:Collected during the period from January 2017 to October 2020,in the treatment of hospitalized patients in neurology department of the First Affiliated Hospital of Nanchang University and Jiangxi Provincial People’s Hospital,at the end of the 38 AE patients were collected.The data of general information,clinical symptoms(including prodrome,original symptom and main clinical symptoms),complications,complicated tumors,serum and cerebrospinal fluid(CSF)examination results,associated antibody,cranial magnetic resonance imaging(MRI),electroencephal-ogram(EEG)results,condition,treatment and prognosis of 38 patients were retrospectively analyzed.Results:1.A total of 38 AE patients were collected,including 21 cases of NMDAR encephalitis,8 cases of GABABR encephalitis,4 cases of LGI1 encephalitis,2 cases of AMPAR2 encephalitis,1 case of LgLON5,DPPX,CASPR2 encephalitis.There are 15 males(39.47%),23 women(60.53%).The majority of adult patients are women,Elderly patients are mostly male(P=0.03).2.Half of the patients(52.63%)had prodrome.The original symptom included mental and behavioral abnormalities(47.36%),seizures(31.59%),cognitive dysfunction(10.53%),involuntary movement,speech difficulties,and limb fatigue(10.53%).The abnormal proportion of mental and behavioral abnormalities in adult patients was significantly higher than that in elderly patients(P=0.04),and that in elderly patients with cognitive impairment was significantly higher than that in adult patients(P=0.02).NMDAR encephalitis has a higher incidence of psychobiological abnormalities than other types of antibodies(P=0.00).GABAbR encephalitis is more common with seizures(P=0.00).The main symptoms include mental and behavioral abnormalities(71.10%),seizures(55.30%),autonomic dysfunction(44.70%),dyskinesia(34.20%),confusion(31.60%),cognitive dysfunction(23.7%).Men are more likely than women to have cognitive decline(P=0.02)and adults are more prone to autonomic dysfunction(P=0.01).Cognitive dysfunction in the elderly was more common than that in adults(P=0.01).The proportion of mental and behavioral abnormalities and autonomic dysfunction in NMDAR encephalitis was higher than that in other types of antibody-associated encephalitis(P=0.03,P=0.05),and the proportion of epileptic seizures in GABAbR encephalitis was slightly higher than that in other types of antibody-associated encephalitis(P=0.01).3.24 Patients had different types of complications:17 cases of pulmonary infection,12 cases of hypoproteinemia,7 cases of abnormal liver function and 6 cases of electrolyte disturbance.4.A total of 8 patients(21.05%)were complicated with tumors,including 4 ovarian teratomas,all anti-NMDAR positive women of reproductive age,3 small cell lung cancer patients,all anti-GABABR positive male patients,and 1 thymoma complicated with AMPAR positive patients.5.There were abnormal thyroid antibody in 15 patients,abnormal immune index in 6 patients,increased myoenzyme in 13 patients.Higher proportion of abnormal thyroid antibody in NMDAR encephalitis than in other antibody types encephalitis(P=0.04).6.There were17 patients with elevated CSF pressure.the cells increased in 22 patients,protein increased in 18 patients,glucose increased in 12 patients,and chloride increased in 8 patients.7.Serum and CSF antibodies were positive in 30 patients.5 patients showed only CSF antibody positive and 3 patients had only serum antibody positive.Compared with serum and CSF antibody titers,CSF antibody titers in the same patient were found to be lower than serum antibody titers(P=0.03).8.There were 21(55.26%)patients with cranial MRI abnormalities,usually unilateral or bilateral hippocampal area or frontal lobe abnormal signal.9.There were 31 cases(81.57%)with different degrees of EEG abnormalities,mainly includes scattered or diffuse medium amplitude or medium of θ waves,some patients with paroxysmal δ brush.The degree of EEG abnormality in adults was higher than that in elderly patients(P=0.01).NMDAR encephalitis was mainly mild and moderate abnormal,GABAR encephalitis was mainly moderate abnormal,while LGI1 encephalitis was mainly normal or mild abnormal.10.The degree of abnormality in EEG was significantly correlated with the condition(r2=0.95,P=0.00),and CSF antibody titers were significantly associated with admission(r2=0.37,p=0.03).11.28 cases(73.68%)had good short-term prognosis,10 cases(26.32%)had poor prognosis,and pulmonary infection,admission and discharge condition,and the degree of EEG abnormality were significantly related to the prognosis.Conclusion:1.The majority of AE patients were young adults aged 20-39,and the ratio of male to female was different in different age groups.Most of the adult patients were female,while most of the elderly patients were male.2.The clinical symptoms of AE were mental and behavioral abnormalities,epileptic seizure,autonomic nervous dysfunction,dyskinesia,confusion,cognitive dysfunction3.Patients with AE have different types of antibodies,and there are differences in the pathogenetic characteristics,immune abnormality,and degree of EEG abnormality.4.Pulmonary infection is the most common complication,and patients with severe pulmonary infection have poor prognosis.5.The higher the antibody titer of cerebrospinal fluid,the more serious the disease is.6.EEG is helpful for the evaluation of the severity and prevention of the patient’s disease.The greater the abnormal degree of EEG,the more serious the disease is and the worse the prognosis is.7.Surgical resection can significantly improve the prognosis of AE patients with teratoma.