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Anti-N-methyl-D-aspartate receptor encephalitis: a prospective study focused on cerebrospinal fluid and clinical

Shouyi Wu1, Huiqin Li2, Yajun Lian3

  • 1Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|May 14, 2020
PubMed
Abstract

Insights

Early diagnosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is aided by analyzing brain MRI, clinical symptoms, and cerebrospinal fluid (CSF) protein levels. Male patients with seizures as an initial symptom may indicate NMDAR encephalitis.

Area of Science:

  • Neurology
  • Immunology

Background:

  • Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune neurological disorder.
  • Early diagnosis is crucial for effective treatment and improved patient outcomes.

Purpose of the Study:

  • To investigate the correlations between brain MRI findings, clinical manifestations, and cerebrospinal fluid (CSF) parameters in NMDAR encephalitis.
  • To establish a reference for the early diagnosis of NMDAR encephalitis.

Main Methods:

  • Prospective observation of 62 NMDAR encephalitis patients (Zhengzhou, China, 2016-2018).
  • Analysis of clinical symptoms, CSF features based on disease duration, and CSF features correlated with brain MRI findings.
  • Specific analysis of CSF characteristics in patients presenting with seizures as the initial symptom.

Main Results:

  • Seizures occurred as the initial symptom in 22.5% of patients, predominantly males (78.57%).
  • CSF total protein abnormalities were significantly higher in the early disease stage compared to middle/late stages (P < 0.05).
  • CSF total protein concentration was significantly higher in patients with abnormal brain MRI findings versus normal MRI (P < 0.05).

Conclusions:

  • Male patients with initial seizures and preceding headaches or fever warrant suspicion for NMDAR encephalitis.
  • CSF demonstrates higher sensitivity for anti-NMDAR antibodies than serum.
  • Elevated CSF total protein is more common in middle/late stages; MRI abnormalities correlate with CSF protein concentration and potentially disease duration.
Keywords:
Anti N-methyl-D-aspartate receptor encephalitisAutoantibodyAutoimmune encephalitisCerebrospinal fluid

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