Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care

Area of Science:

• Neurology
• Immunology
• Critical Care Medicine

Background:

• Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a leading cause of immune-mediated encephalitis.
• Limited data exist on intensive care unit (ICU) management for anti-NMDAR encephalitis patients.

Purpose of the Study:

• To identify prognostic factors for good neurologic outcome in ICU-admitted patients with anti-NMDAR encephalitis.
• To evaluate the impact of early treatment on patient recovery.

Main Methods:

• Observational multicenter study of adult patients diagnosed with anti-NMDAR encephalitis admitted to the ICU (2008-2014).
• Primary outcome: good neurologic outcome (modified Rankin Scale 0-2) at 6 months post-ICU admission.
• Analysis of first-line and second-line immunotherapy, and clinical factors associated with outcome.

Main Results:

• 57% of patients achieved a good neurologic outcome at 6 months.
• Early immunotherapy (≤8 days) significantly improved outcomes (OR, 16.16).
• Low white blood cell count in cerebrospinal fluid was associated with better outcomes (OR, 9.83).

Conclusions:

• Adult patients with anti-NMDAR encephalitis requiring ICU care have a good prognosis.
• Early and aggressive immunotherapy is critical for favorable neurologic outcomes.
• Prompt diagnosis and treatment initiation are strongly advocated.