CSF findings in patients with anti-N-methyl-d-aspartate receptor-encephalitis

Wang, Rui; Guan, Hongzhi; Ren, Haitao; Wang, Wei; Zhao, Hong; Zhou, Dong

doi:10.1016/j.seizure.2015.04.005

Cited by 88 publications

(68 citation statements)

References 20 publications

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“…Similarly, abnormal EEG, MRI, and CSF at first disease event did not differ substantially between patients with relapsing and monophasic disease. Long‐term neurological outcome (mRS) was not affected by abnormal CSF findings in a published cohort of 43 patients, although CSF data in monophasic and relapsing patients were not provided . While these investigations did not prove useful in predicting the risk of relapse in our cohort, EEG remains a sensitive marker in the early phases of encephalitis, and the relationship between EEG features and disease severity and course is being explored closely in the recent literature …”

Section: Discussionmentioning

confidence: 84%

Relapse risk factors in anti‐N‐methyl‐D‐aspartate receptor encephalitis

Nosadini

Granata²,

Matricardi³

et al. 2019

Develop Med Child Neuro

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Aim To identify factors that may predict and affect the risk of relapse in anti‐N‐methyl‐D‐aspartate receptor (NMDAR) encephalitis. Method This was a retrospective study of an Italian cohort of patients with paediatric (≤18y) onset anti‐NMDAR encephalitis. Results Of the 62 children included (39 females; median age at onset 9y 10mo, range 1y 2mo–18y; onset between 2005 and 2018), 21 per cent relapsed (median two total events per relapsing patient, range 2–4). Time to first relapse was median 31.5 months (range 7–89mo). Severity at first relapse was lower than onset (median modified Rankin Scale [mRS] 3, range 2–4, vs median mRS 5, range 3–5; admission to intensive care unit: 0/10 vs 3/10). At the survival analysis, the risk of relapsing was significantly lower in patients who received three or more different immune therapies at first disease event (hazard ratio 0.208, 95% confidence interval 0.046–0.941; p=0.042). Neurological outcome at follow‐up did not differ significantly between patients with relapsing and monophasic disease (mRS 0–1 in 39/49 vs 12/13; p=0.431), although follow‐up duration was significantly longer in relapsing (median 84mo, range 14–137mo) than in monophasic patients (median 32mo, range 4–108mo; p=0.002). Interpretation Relapses may occur in about one‐fifth of children with anti‐NMDAR encephalitis, are generally milder than at onset, and may span over a long period, although they do not seem to be associated with severity in the acute phase or with outcome at follow‐up. Aggressive immune therapy at onset may reduce risk of relapse. What this paper adds Relapses of anti‐N‐methyl‐D‐aspartate receptor encephalitis may span over a long period. Relapses were not associated with severity in the acute phase or outcome at follow‐up. Aggressive immune therapy at onset appears to decrease risk of relapse.

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Section: Discussionmentioning

confidence: 84%

Relapse risk factors in anti‐N‐methyl‐D‐aspartate receptor encephalitis

Nosadini

Granata²,

Matricardi³

et al. 2019

Develop Med Child Neuro

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“…CSF findings were abnormal in most cases,19,20 albeit nonspecific 21. Lymphocytic pleocytosis and increased CSF protein was the commonest finding.…”

Section: Csf Findingsmentioning

confidence: 88%

The Laboratory Diagnosis of Autoimmune Encephalitis

Lee

2016

J Epilepsy Res

104

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Autoimmune encephalitis is a group of encephalitis syndromes that cause altered mentality, memory decline, or seizures in association with the presence of serum and cerebrospinal fluid (CSF) autoantibodies (auto-Abs). An early diagnosis enables early treatments. The detection of auto-Abs is a confirmatory diagnosis. Tissue-based assay, cell-based immunoassay, and immunoblotting are used to detect various autoantibodies. The CSF test for the presence of antibodies is important because it is more sensitive and reflects disease activity in many autoimmune encephalitis, although antibody tests can be negative even in the presence of autoimmune encephalitis. EEG is often abnormal, but nonspecific. A unilateral or bilateral medial temporal T2 high signal is a common finding in MRI. Fludeoxyglucose-positron emission tomography is sometimes useful for diagnosis in patients with normal MRI.

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“…75 Findings from three other studies have suggested that serum testing is less consistent, or showed antibodies in patients without anti-NMDA receptor encephalitis or immune-mediated disorders. 74,76,77 …”

Section: Approach To Patients With Clinically Recognisable Syndromesmentioning

confidence: 99%

A clinical approach to diagnosis of autoimmune encephalitis

Graus

Titulaer

Balu

et al. 2016

The Lancet Neurology

3,080

3,590

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Encephalitis is a severe inflammatory disorder of the brain with many possible causes and a complex differential diagnosis. Advances in autoimmune encephalitis research in the past 10 years have led to the identification of new syndromes and biomarkers that have transformed the diagnostic approach to these disorders. However, existing criteria for autoimmune encephalitis are too reliant on antibody testing and response to immunotherapy, which might delay the diagnosis. We reviewed the literature and gathered the experience of a team of experts with the aims of developing a practical, syndrome-based diagnostic approach to autoimmune encephalitis and providing guidelines to navigate through the differential diagnosis. Because autoantibody test results and response to therapy are not available at disease onset, we based the initial diagnostic approach on neurological assessment and conventional tests that are accessible to most clinicians. Through logical differential diagnosis, levels of evidence for autoimmune encephalitis (possible, probable, or definite) are achieved, which can lead to prompt immunotherapy.

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CSF findings in patients with anti-N-methyl-d-aspartate receptor-encephalitis

Abstract: The sensitivity of NMDA receptor antibody testing is higher in CSF compared to serum. Other CSF abnormalities are present in some patients with Anti-NMDAR-encephalitis, however these changes do not appear to affect prognosis.

Cited by 88 publications

References 20 publications

Relapse risk factors in anti‐N‐methyl‐D‐aspartate receptor encephalitis

Relapse risk factors in anti‐N‐methyl‐D‐aspartate receptor encephalitis

The Laboratory Diagnosis of Autoimmune Encephalitis

A clinical approach to diagnosis of autoimmune encephalitis

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