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Published on: January 9, 2018
Treatment principles of ovarian teratoma with anti-N-methyl-D-aspartate receptor encephalitis
Ying Bai1, Qiyun Guan1, Jinting Jiang1
1Peking Union Medical College Hospital, Beijing, 100730, China.
Purpose:
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently discovered paraneoplastic limbic encephalitis. Ovarian teratoma is the only tumor clearly related to anti-NMDAR encephalitis occurrence. This study aimed to assess ovarian teratoma for neurological and mental symptoms highly related with anti-NMDAR encephalitis, treatment principles, and prognosis.
Methods:
Between June 2011 and October 2014, in Peking Union Medical College Hospital, ten patients with ovarian teratoma associated with anti-NMDAR encephalitis were enrolled. All patients underwent laparoscopic oophorocystectomy followed by immunotherapy.
Results:
In nine patients, mental and neurological symptoms were significantly relieved 13.7 ± 5.5 days after surgery; however, symptoms persisted in one patient, who was still hospitalized when writing this paper. During the postoperative follow-up period, seven patients showed no mental symptoms or tumor recurrence; one subject had symptom recurrence 28 days after surgery, while another patient showed suspected tumor recurrence 273 days after operation.
Conclusions:
Ovarian teratoma associated with anti-NMDAR encephalitis is usually associated with neurological and mental symptoms at onset. Its manifestations are complex, and nursing care is difficult. Laparoscopic oophorocystectomy followed by immunotherapy led to symptom resolution in most patients.
Insights
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, often linked to ovarian teratomas, typically presents with neurological and mental symptoms. Surgical removal of the teratoma combined with immunotherapy effectively resolves symptoms in most affected patients.
Area of Science:
- Neurology
- Oncology
- Immunology
Background:
- Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a paraneoplastic limbic encephalitis.
- Ovarian teratoma is the primary associated tumor.
- This condition presents with complex neurological and mental symptoms.
Purpose of the Study:
- To evaluate neurological and mental symptoms in ovarian teratoma-associated anti-NMDAR encephalitis.
- To assess treatment principles for this condition.
- To determine the prognosis of patients with ovarian teratoma and anti-NMDAR encephalitis.
Main Methods:
- Ten patients with ovarian teratoma and anti-NMDAR encephalitis were enrolled.
- All patients underwent laparoscopic oophorocystectomy.
- Immunotherapy was administered post-surgery.
Main Results:
- Nine patients experienced significant symptom relief within 13.7 ± 5.5 days post-surgery.
- Seven patients remained symptom-free with no tumor recurrence during follow-up.
- Recurrence of symptoms or suspected tumor recurrence occurred in two patients.
Conclusions:
- Ovarian teratoma-associated anti-NMDAR encephalitis commonly manifests with neurological and mental symptoms.
- Laparoscopic oophorocystectomy followed by immunotherapy is an effective treatment strategy.
- Most patients achieve symptom resolution, but recurrence is possible.
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