Investigate The Neuroprotective Study Of Anti-N-methyl-D-aspartate Receptor Encephalitis Based On Neurotransmitter Imbalance

Objective: To observe the clinical efficacy of olanzapine,magnesium valproate and lamotrigine in patients with anti-NMDAR encephalitis who presenting primarily with mental symptoms,and to explore the correlation between neurotransmitter imbalance and the pathogenesis of anti-NMDAR encephalitis,in order to optimize the treatment of anti-NMDAR encephalitis.Methods : 90 eligible patients with anti-NMDAR encephalitis were randomly divided into olanzapine group(n=36),magnesium valproate group(n=30)and lamotrigine group(n=24).The efficacy and safety of the three groups were observed,and the power of Glu and GABA were measured by encephalofluctuograph before treatment and three months after treatment,and the ratio of Glx/Cr in the left frontal lobe was measured by magnetic resonance spectrum,so as to explore the changes of neurotransmitters before and after treatment.Results:1.Comparison of clinical efficacy :(1)Mental symptoms: After 3 weeks and 3 months,the total score of PANSS,positive symptom score,negative symptom score and general psychopathology score of the three groups were significantly lower than before(all P<0.05).After 3 weeks,the total score of PANSS,positive symptom score and BPRS score of magnesium valproate group and lamotrigine group were significantly lower than those of olanzapine group(all P<0.05),and the general psychopathological score of magnesium valproate group was significantly lower than those of olanzapine group and lamotrigine group(all P<0.05).After 3 months,the total score of PANSS,negative symptoms and BPRS in magnesium valproate group and lamotrigine group were significantly lower than those in olanzapine group(all P<0.05).(2)EEG improvement: After 3 weeks,the graded improvement rate of EEG in olanzapine group and magnesium valproate group had no significant change than before(both P>0.05),while the graded improvement rate of EEG in lamotrigine group was significantly increased(P<0.05).After 3 months,the graded improvement rate of EEG in the three groups was significantly higher than that before treatment(P<0.05).After 3 weeks,there was no significant difference in the grade improvement rate of EEG among the three groups(P>0.05).After 3 months,the graded improvement rate of EEG in magnesium valproate group and lamotrigine group was higher than that in olanzapine group(all P<0.05).(3)Cognitive function: after 3 weeks and 3 months,the Mo CA scores of the three groups were significantly higher than those before treatment(all P<0.05).After 3 weeks and 3 months,the Mo CA scores of magnesium valproate group and lamotrigine group were significantly higher than those of olanzapine group(all P<0.05).(4)Other indicators: the onset time of lamotrigine group was significantly shorter than that of olanzapine group(P<0.05);The days of ICU treatment and total hospital stay in olanzapine group were significantly higher than those in magnesium valproate group and lamotrigine group(all P<0.05).After 3 months,there was no significant difference in the negative conversion rate of serum anti-NMDAR antibody and cerebrospinal fluid anti-NMDAR antibody among the three groups(all P>0.05).2.Shortterm prognosis and recurrence: after 3 months,the m Rs score and recurrence rate of olanzapine group were significantly higher than those of magnesium valproate group and lamotrigine group(all P<0.05).3.Safety: there was no significant difference in the incidence of adverse reactions among the three groups(P>0.05)4.Changes in neurotransmitters of anti-NMDAR encephalitis: before treatment,the power of Glu was significantly increased and the power of GABA was significantly decreased in 90 patients with anti-NMDAR encephalitis compared with the norm.5.Changes of neurotransmitters before and after treatment: there were no significant differences in Glu,GABA power and left frontal Glx/Cr in olanzapine group before and after treatment(all P>0.05);after treatment,Glu power and left frontal Glx/Cr in magnesium valproate group and lamotrigine group were lower than that before treatment(all P<0.05);after treatment,GABA power was higher than that before treatment(all P<0.05).Conclusion:1.Patients with anti-NMDAR encephalitis have imbalance of transmitters of Glu and GABA.‘The combination of anti-NMDAR antibody and NMDAR mediates the down-regulation of NMDAR and thus leads to the imbalance of neurotransmitters ’may be one of the important pathogenesis of anti-NMDAR encephalitis,and improving the imbalance of neurotransmitters has important positive significance for the treatment of the disease.2.Among the three common neurotransmitter regulating drugs,magnesium valproate and lamotrigine show better efficacy than olzapine in the treatment of NMDAR encephalitis.‘Immunotherapy +preferred neurotransmitter regulating therapy ’ can be used as a new idea for the clinical treatment of NMDAR encephalitis.