Four-Year Course of Serum and Cerebrospinal Fluid Antibody Titers in a Patient with Anti-NMDAR Encephalitis

2014 ◽  
Vol 05 (03) ◽  
Author(s):  
Hiroshi Kataoka
Keyword(s):  
Cerebrospinal Fluid ◽  
Nmdar Encephalitis ◽  
Antibody Titers

Analysis of Relation Between Electroclinical Features and Cerebrospinal Fluid Antibody Titers in Patients With anti-NMDAR Encephalitis

2018 ◽  
Vol 50 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Ailiang Miao ◽  
Mingyang Du ◽  
Lingling Wang ◽  
Jianqing Ge ◽  
Hengdong Lu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Symptoms ◽  
Behavioral Changes ◽  
Female Patients ◽  
Nmdar Encephalitis ◽  
Initial Symptoms ◽  
Scale Scores ◽  
Antibody Titers ◽  
Male Patients ◽  
Eeg Recordings

Purpose. This study aimed to determine the relation between electroclinical features and cerebrospinal fluid (CSF) antibody titers in patients with anti- N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. Method. Clinical symptoms and electroencephalography (EEG) at different stages were analyzed in 51 hospitalized patients with anti-NMDAR encephalitis. Results. Behavioral changes were the initial symptoms in 90.9% (20/22) of female patients with high (1:10 or 1:32) CSF antibody titers. A greater number of clinical symptoms were observed in the patients with high CSF antibody titers than in those with low (1:1 or 1:3.2) CSF antibody titers (mean 3.11 ± 1.06 vs 1.62 ± 0.65, P = .000). The number of clinical symptoms was greater in the female patients than in the male patients (mean 3.52 ± 0.98 vs 2.69 ± 1.09, P = .000). At the peak stage, worse background activity (BA) in EEG recordings was observed in patients with high CSF antibody titers than in those with low CSF antibody titers (Mann-Whitney U test, P = .001). The peak-stage BA in EEG was worse in female patients than in male patients (Mann-Whitney U test, P = .000). Modified Rankin scale scores were higher in patients with high CSF antibody titers than in those with low CSF antibody titers (mean 2.62 ± 1.42 vs 0.75 ± 0.97, P = .000). Brush patterns and constant chewing were observed primarily in female patients with high CSF antibody titers. Epileptic discharges were located predominately in the frontal regions and were noted to vary. Conclusion. The electroclinical features of patients with anti-NMDAR encephalitis were associated with gender and CSF antibody titers.

scholarly journals Non-inflammatory cerebrospinal fluid delays the diagnosis and start of immunotherapy in anti-NMDAR encephalitis

2018 ◽  
Vol 76 (1) ◽  
pp. 2-5 ◽  
Author(s):  
Mariana Espinola-Nadurille ◽  
Paola Bautista-Gomez ◽  
Jose Flores ◽  
Veronica Rivas-Alonso ◽  
Rodrigo Perez-Esparza ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Symptom Onset ◽  
Correct Diagnosis ◽  
Retrospective Data ◽  
Csf Analysis ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Neuropsychiatric Manifestations ◽  
Inflammatory Pattern ◽  
Autoimmune Encephalopathy

ABSTRACT Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a form of autoimmune encephalopathy that presents with a wide variety of symptoms, including neuropsychiatric manifestations. The authors’ aim for this study was to analyze the results of paraclinical studies of patients with a diagnosis of anti-NMDAR encephalitis and the association between symptom onset and diagnosis, and start of immunotherapy. Retrospective data of 29 patients with anti-NMDAR encephalitis were gathered and analyzed. Abnormal EEG was found in 27 patients (93.1%), whereas MRI was abnormal in 19 patients (65.5%). In contrast, an inflammatory pattern on CSF analysis was found in only 13 patients (44.8%). The absence of pleocytosis or increased proteins in the CSF was associated with a longer time from symptom onset to diagnosis and treatment (p = 0.003). The authors conclude that noninflammatory CSF may delay the correct diagnosis and start of immunotherapy in anti-NMDAR encephalitis. In the presence of suggestive clinical features, extensive studies including EEG are recommended.

Th17 cells were recruited and accumulated in the cerebrospinal fluid and correlated with the poor prognosis of anti-NMDAR encephalitis

2018 ◽  
Vol 50 (12) ◽  
pp. 1266-1273 ◽  
Author(s):  
Chaosheng Zeng ◽  
Lin Chen ◽  
Bocan Chen ◽  
Yi Cai ◽  
Pengxiang Li ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Th17 Cells ◽  
Poor Prognosis ◽  
The Poor ◽  
Nmdar Encephalitis

scholarly journals Clinical features and influencing prognostic factors in patients with anti-NMDAR encephalitis: a cohort follow-up study in Chinese patients

2019 ◽  
Author(s):  
Yingxin Wang ◽  
Ailiang Miao ◽  
Yongwei Shi ◽  
Jianqing Ge ◽  
Lingling Wang ◽  
...  
Keyword(s):  
Clinical Features ◽  
East China ◽  
Factors Associated ◽  
Female Patients ◽  
Nmdar Encephalitis ◽  
Consciousness Disturbance ◽  
Initial Symptoms ◽  
Antibody Titers ◽  
Male Patients ◽  
Poor Outcomes

Abstract Objectives The clinical manifestations of patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis in East China and factors associated with prognosis were analyzed.Methods A retrospective study of 106 patients (58 females; 48 males) with anti-NMDAR encephalitis in East China was carried out from June 2015 to February 2019. Clinical features and factors influencing outcomes were reviewed.Results Behavioral changes were observed in 74.5% (79/106) of patients, and comprised the initial symptoms in 61.3% (65/106). Seizures were observed in 67% (71/106) of patients, and served as initial symptoms in 31.1% (33/106). A total of 54.9% (39/71) of seizures were focal seizures. More clinical symptoms were observed in female patients than in male patients ( P =0.000). Similarly, background activity (BA) with cerebrospinal fluid (CSF) antibody titers at the peak stage was more severe in female patients than in male patients ( P = 0.000). The Binary logistic regression and ROC curve analyses revealed the factors associated with poor outcomes included consciousness disturbance (OR: 4.907, 95% CI: 1.653-14.562, P =0.004; area: 65.4%, sensitivity: 44.2%, specificity: 86.5%, P =0.014 ), EEG BA (OR: 3.743, 95% CI: 1.766-7.932, P =0.001; area: 76.6%, sensitivity: 73%, specificity: 75%, P =0.000), number of symptoms (OR: 2.911, 95% CI: 1.811-4.679, P =0.000; area: 77.1%, sensitivity: 59.5%, specificity: 78.6%, P =0.000) and CSF antibody titer (OR: 31.778, 95% CI: 8.891-113.57, P =0.000; area: 83.9%, sensitivity: 89.2%, specificity: 78.6%, P =0.000).Conclusions EEG BA and number of symptoms were associated with CSF antibody titers. Consciousness disturbances, EEG BA, number of symptoms and CSF antibody titers served as predictors of poor outcomes.

scholarly journals Lyme Disease and Associated NMDAR Encephalitis: A Case Report and Literature Review

2021 ◽  
Vol 13 (4) ◽  
pp. 487-496
Author(s):  
Natalja Predkele ◽  
Jānis Mednieks
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Marked Improvement ◽  
Clinical Signs ◽  
Antibacterial Treatment ◽  
Speech Impairments ◽  
Igg Antibodies ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Csf Findings

We present a case of a patient with positive N-methyl-D-aspartate receptor (NMDAR) IgG antibodies in their serum and cerebrospinal fluid (CSF) associated with neuroborreliosis. Clinically, the patient presented with symptoms of confusion, as well as behavioral and speech impairments. Regardless of antibacterial treatment, no significant improvement was achieved. Methylprednisolone provided a marked improvement in the patient’s clinical signs and CSF findings. The screening did not reveal any underlying neoplasm. Taking into account the marked clinical improvement after treatment with glucocorticosteroids, we suggest that NMDAR encephalitis is a possible autoimmune complication in neuroborreliosis patients requiring additional immunotherapy.

Pertussis Encephalopathy With High Cerebrospinal Fluid Antibody Titers to Pertussis Toxin and Filamentous Hemagglutinin

PEDIATRICS ◽  
1998 ◽  
Vol 102 (4) ◽  
pp. 986-989 ◽  
Author(s):  
Cameron C. Grant ◽  
E. John McKay ◽  
Dr Med Sci ◽  
Alan Simpson ◽  
David Buckley
Keyword(s):  
Cerebrospinal Fluid ◽  
Pertussis Toxin ◽  
Filamentous Hemagglutinin ◽  
Antibody Titers

Pediatric N-Methyl-d-Aspartate (NMDA) Receptor Encephalitis, With and Without Herpes Encephalitis

2021 ◽  
pp. 088307382110026
Author(s):  
Lydia Marcus ◽  
Jayne M. Ness
Keyword(s):  
Cerebrospinal Fluid ◽  
Movement Disorders ◽  
Demographic Data ◽  
Outcome Data ◽  
Behavioral Symptoms ◽  
Herpes Encephalitis ◽  
Nmda Receptor Encephalitis ◽  
Nmdar Encephalitis ◽  
Diagnostic Management ◽  
History Of

Objective: To compare clinical, diagnostic, management, and outcome factors in children with anti– N-methyl-d-aspartate receptor (NMDAR) encephalitis and a history of herpes simplex encephalitis (HSE) to children with NMDAR encephalitis without a history of HSE. Methods: All patients with anti-NMDAR antibodies in cerebrospinal fluid treated at our institution between 2012 and 2019 were identified and divided into those with a history of HSE (HSE+NMDAR group) and those without a history of HSE (NMDAR-only group). Demographic data, clinical characteristics, immunotherapy, and outcome data were collected on all patients and compared between the 2 groups. Results: Seventeen patients were identified with anti-NMDAR antibodies in cerebrospinal fluid, 6 of whom had a history of HSE. Mean age in the HSE+NMDAR cohort was significantly younger in the HSE+NMDAR cohort, as 5 of the 6 patients were infants. Of HSE+NMDAR patients, 50% had behavioral symptoms, 67% had movement disorders, and 100% had seizures at disease nadir. In the NMDAR-only group, 100% had behavioral symptoms, 73% had movement disorders, and 73% had seizures at nadir. HSE+NMDAR patients received a median of 1 immunotherapy, compared to a median of 4.5 immunotherapies in the NMDAR-only group. Conclusion: Behavioral symptoms were more common in NMDAR-only patients, whereas seizures were more common in HSE+NMDAR patients. Both groups had significant disability at disease nadir, with more improvement in disability over time in the NMDAR-only group. HSE+NMDAR patients received fewer immunotherapies than NMDAR-only patients. Outcomes of infants with HSE appear to primarily reflect sequelae from HSE.

scholarly journals Characteristics of cerebrospinal fluid cytology in anti-N-methyl-D-aspartate receptor encephalitis

2020 ◽  
Author(s):  
Huiqin Liu ◽  
Haitao Ren ◽  
Yanhuan Zhao ◽  
Siyuan Fan ◽  
Xinya Gao ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Plasma Cells ◽  
White Cell Count ◽  
Oligoclonal Bands ◽  
Csf Cytology ◽  
College Hospital ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Inflammatory State ◽  
Serious Disease

Abstract Background: The aim of the current study was to explore the characteristics of cerebrospinal fluid (CSF) cytology in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Methods: CSF was collected from patients with anti-NMDAR encephalitis at Peking Union Medical College Hospital and Henan Provincial People’s Hospital from 01 January 2015 to 31 December 2018. Cytological characteristics and other parameters of the CSF were analyzed. Results: CSF cytological data were obtained from 164 patients with anti-NMDAR encephalitis. Visible signs of inflammation were identified in cytological analyses of 112 patients’ CSF, including 46 cases of mild inflammation, 58 of moderate inflammation, and 8 of severe inflammation. With regard to inflammation type, 89 cases were classified as lymphocytic inflammation, 22 as mixed inflammation with both lymphocytes and neutrophils, and 1 case was classified as mixed inflammation with lymphocytes, neutrophils, and eosinophils. Activated lymphocytes were detected in 51 patients, and plasma cells were detected in 16. Oligoclonal bands were detected in 111/164 patients, and 51 patients were positive for specific oligoclonal bands in CSF. The positivity rate was 45.9%. In non-pleocytosis subgroup based on routine CSF examination, mRS score was positively correlated with white cell count and degree of inflammation determined via CSF cytology (rho = 0.259, p = 0.047; rho = 0.264, p = 0.043, respectively), and patients with CSF inflammation detected by cytology were likely to have more serious disease severity (mRS>3) ( χ2 = 5.544, p = 0.019) in comparison to patients with negative cytological findings. Conclusions: The superiority of evaluating cell morphology and the ability of detecting inflammatory state that has not been exhibited in routine examination render CSF cytology a candidate for identifying anti-NMDAR encephalitis and investigating its pathogenesis.

scholarly journals High Level of Soluble CD146 In Cerebrospinal Fluid Might be a Biomarker of Severity of Anti-N-Methyl-D-Aspartate Receptor Encephalitis

2021 ◽  
Vol 12 ◽  
Author(s):  
Qing Li ◽  
Jinglong Chen ◽  
Mengzhuo Yin ◽  
Jun Zhao ◽  
Fuchang Lu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Neurological Diseases ◽  
Neurological Status ◽  
Acute Stage ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Potential Biomarker ◽  
Tnf Α ◽  
Multi Center Study ◽  
High Level

BackgroundDisruption of the blood–brain barrier (BBB) is an important pathophysiological process of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. A recent multi-center study showed that soluble (s) CD146 is a potential biomarker for monitoring early BBB damage and central nervous system inflammation, but little is known about sCD146 in anti-NMDAR encephalitis.MethodTwenty-three anti-NMDAR encephalitis patients and seventeen controls with non-inflammatory neurological diseases were recruited. sCD146 and inflammatory cytokines in cerebrospinal fluid (CSF) and serum were detected by ELISA. Modified Rankin scale (mRS) scores were used to assess the neurological status of each patient. A follow-up review was completed three months after discharge.ResultssCD146 levels in the CSF of patients with the acute stage anti-NMDAR encephalitis were significantly increased compared with controls and accompanied by increases in TNF-α, IL-6 and IL-10. CSF sCD146 was positively correlated with neuroinflammatory factors in the CSF and with mRS score. Three months after effective treatment, CSF sCD146 in patients was significantly decreased but remained significantly different compared with the controls.ConclusionOur data suggested that higher expression of CSF sCD146 correlated with more serious neurological damage. Therefore, levels of CSF sCD146 may represent a promising indicator for monitoring disease and optimizing clinical treatment decisions in the early stages of anti-NMDAR encephalitis.

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