Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Favorable Outcome Despite Prolonged Status Epilepticus

Lenoir, Xavier Finné; Sindic, Christian; Pesch, Vincent Van; Sankari, Souraya El; Tourtchaninoff, Marianne de; Denays, Roger; Hantson, Philippe

doi:10.1007/s12028-012-9788-8

Cited by 22 publications

(5 citation statements)

References 10 publications

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“…Early and reliable identification of patients with potential favorable outcome despite having SE for several days is of outmost clinical importance, as this insight may urge clinicians to intensify treatment rather than consider care withdrawal as systemic and neurologic sequelae increase, and chances of SE termination decrease over time. Good outcome is possible after prolonged treatment refractory or super‐refractory SE, with some patients returning to their premorbid status, even after >90 days of SE …”

Section: Discussionmentioning

confidence: 99%

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

et al. 2018

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Objectives: Early identification of patients who are at risk of prolonged status epilepticus (SE) and patients with high chances of full recovery despite prolonged SE may urge clinicians to intensify treatment rather than to withdraw care. We aimed to develop prediction models based on readily available clinical parameters to predict prolonged SE at seizure onset and to identify patients with high chances for full recovery. Methods: From 2005 to 2016, all adult SE patients treated at the University Hospital Basel, a Swiss medical care center, were included. Multivariable Poisson regression was performed to identify predictors of prolonged SE (defined as SE for >12, >24, and >48 hours) and return to baseline from prolonged SE. The area under the receiver-operating characteristic curves (AUROC) for prediction models was calculated. Results: Of 467 patients, the median age was 66.7 years and mortality was 12%.Relative risk (RR) for death was 1.06 (P < 0.0001) with every SE day. In multivariable analysis, nonconvulsive SE with coma, SE severity score ≥3, and acute brain lesions at SE onset independently predicted prolonged SE with an AUROC of 0.68 for >12, 0.67 for >24, and 0.72 for >48 hours of SE. Absence of nonconvulsive SE with coma and a decreasing Charlson comorbidity index were independent predictors for return to baseline in prolonged SE with an AUROC of 0.82 and 0.76 following cross-validation. Both associations remained significant despite adjustments for determinants of adverse outcome, such as anesthetics and vasopressors (nonconvulsive SE with coma RR = 0.24, 95% confidence interval [CI] 0.07-0.86; comorbidity index RR = 0.87, 95% CI 0.76-0.99). Significance: Although our data indicate that identification of prolonged SE at seizure onset is unreliable, timely recognition of patients with high chances of good outcome despite prolonged SE is promising on the basis of comorbidities, type of SE, and level of consciousness. Further external validation of this prediction model is needed.

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Section: Discussionmentioning

confidence: 99%

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

et al. 2018

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“…In children and adolescents, seizures are usually partial motor or complex seizures [6]. Even, anti-NMDAR encephalitis causes prolonged status epilepticus [50, 51], which carries a poor prognosis, with a mortality rate of 56% [52]. …”

Section: Clinical Manifestationsmentioning

confidence: 99%

Anti-N-Methyl-D-aspartate Receptor Encephalitis: A Severe, Potentially Reversible Autoimmune Encephalitis

Liu

Zhu

Zheng

et al. 2017

Mediators of Inflammation

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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is potentially lethal, but it is also a treatable autoimmune disorder characterized by prominent psychiatric and neurologic symptoms. It is often accompanied with teratoma or other neoplasm, especially in female patients. Anti-NMDAR antibodies in cerebrospinal fluid (CSF) and serum are characteristic features of the disease, thereby suggesting a pathogenic role in the disease. Here, we summarize recent studies that have clearly documented that both clinical manifestations and the antibodies may contribute to early diagnosis and multidisciplinary care. The clinical course of the disorder is reversible and the relapse could occur in some patients. Anti-NMDAR encephalitis coexisting with demyelinating disorders makes the diagnosis more complex; thus, clinicians should be aware of the overlapping diseases.

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“…Liu X et al reported that 22 patients with SE required ASM and anesthetics, of whom 13 patients (59.1%) had controlled SE, while another 9 patients (40.9%) had unremitting or remitting SE after reduction or discontinuation of anesthetics, relapsed and eventually died in the acute phase ( 14 ). Finné Lenoir X et al reported a case of anti-NMDAR encephalitis in a 17-year-old Asian male in whom a large number of ASMs were ineffective in his prolonged persistent epilepsy ( 16 ). In addition to conventional ASMs, Santoro et al reported ketamine as an effective adjunctive therapy for hyper refractory persistent epilepsy in patients with anti-NMDAR receptor encephalitis, suggesting that administration of a loading dose followed by maintenance infusion resulted in clinical and/or electrogram seizure cessation in less than 48 h ( 17 ).…”

Section: Resultsmentioning

confidence: 99%

Use of anti-seizure medications in different types of autoimmune encephalitis: A narrative review

Guo

2023

Front. Neurol.

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Seizures are the main manifestation of the acute phase of autoimmune encephalitis (AE). Anti-seizure medications (ASMs) play an important role in controlling seizures in AE patients, but there is currently a lack of consensus regarding the selection, application, and discontinuation of ASMs. This narrative review focuses on the use of ASMs in patients with AE driven by different antibodies. The PubMed, Embase, and MEDLINE databases were searched up until 30 October 2022 using prespecified search terms. We identified 2,580 studies; 23 retrospective studies, 2 prospective studies and 9 case reports were evaluated based on our inclusion criteria. Anti-N-methyl-D-aspartic-acid-receptor (anti-NMDAR) encephalitis is the type of AE that responds best to ASMs, and long-term or combined use of ASMs may be not required in most patients with seizures; these results apply to both adults and children. Sodium channel blockers may be the best option for seizures in anti-leucine-rich-glioma-inactivated-1 (anti-LGI1) encephalitis, but patients with anti-LGI1 encephalitis are prone to side effects when using ASMs. Cell surface antibody-mediated AE patients are more likely to use ASMs for a long period than patients with intracellular antibody-mediated AE. Clinicians can score AE patients’ clinical characteristics on a scale to identify those who may require long-or short-term use of ASMs in the early stage. This review provides some recommendations for the rational use of ASMs in encephalitis mediated by different antibodies with the aim of controlling seizures and avoiding overtreatment.

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Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Favorable Outcome Despite Prolonged Status Epilepticus

Cited by 22 publications

References 10 publications

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

Anti-N-Methyl-D-aspartate Receptor Encephalitis: A Severe, Potentially Reversible Autoimmune Encephalitis

Use of anti-seizure medications in different types of autoimmune encephalitis: A narrative review

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