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Analysis of relapses in anti-NMDAR encephalitis.
Neurology. 2011 Sep 06; 77(10):996-9.Neur

Abstract

OBJECTIVE

The clinical characteristics of patients with relapsing anti-NMDA receptor (NMDAR) encephalitis are not well-defined. In this study, we report the clinical profile and outcome of relapses in a series of anti-NMDAR encephalitis.

METHODS

We did a retrospective review of relapses that occurred in 25 patients with anti-NMDAR encephalitis. Relapses were defined as any new psychiatric or neurologic syndrome, not explained by other causes, which improved after immunotherapy or, less frequently, spontaneously.

RESULTS

A total of 13 relapses were identified in 6 patients. Four of them had several, 2 to 4, relapses. There was a median delay of 2 years (range 0.5 to 13 years) for the first relapse. Median relapse rate was 0.52 relapses/patient-year. Relapse risk was higher in patients who did not receive immunotherapy in the first episode (p = 0.009). Most cases (53%) presented partial syndromes of the typical anti-NMDAR encephalitis. Main symptoms of relapses were speech dysfunction (61%), psychiatric (54%), consciousness-attention disturbance (38%), and seizures (31%). Three relapses (23%) presented with isolated atypical symptoms suggestive of brainstem-cerebellar involvement. An ovarian teratoma was detected at relapse in only 1 patient (17%). Relapses did not add residual deficit to that caused by the first episode.

CONCLUSIONS

Relapses in anti-NMDAR encephalitis are common (24%). They may occur many years after the initial episode. Relapses may present with partial aspects or with isolated symptoms of the full-blown syndrome. Immunotherapy at first episode reduces the risk of relapses.

Authors+Show Affiliations

Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d’Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21865579

Citation

Gabilondo, I, et al. "Analysis of Relapses in anti-NMDAR Encephalitis." Neurology, vol. 77, no. 10, 2011, pp. 996-9.
Gabilondo I, Saiz A, Galán L, et al. Analysis of relapses in anti-NMDAR encephalitis. Neurology. 2011;77(10):996-9.
Gabilondo, I., Saiz, A., Galán, L., González, V., Jadraque, R., Sabater, L., Sans, A., Sempere, A., Vela, A., Villalobos, F., Viñals, M., Villoslada, P., & Graus, F. (2011). Analysis of relapses in anti-NMDAR encephalitis. Neurology, 77(10), 996-9. https://doi.org/10.1212/WNL.0b013e31822cfc6b
Gabilondo I, et al. Analysis of Relapses in anti-NMDAR Encephalitis. Neurology. 2011 Sep 6;77(10):996-9. PubMed PMID: 21865579.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Analysis of relapses in anti-NMDAR encephalitis. AU - Gabilondo,I, AU - Saiz,A, AU - Galán,L, AU - González,V, AU - Jadraque,R, AU - Sabater,L, AU - Sans,A, AU - Sempere,A, AU - Vela,A, AU - Villalobos,F, AU - Viñals,M, AU - Villoslada,P, AU - Graus,F, Y1 - 2011/08/24/ PY - 2011/8/26/entrez PY - 2011/8/26/pubmed PY - 2011/11/1/medline SP - 996 EP - 9 JF - Neurology JO - Neurology VL - 77 IS - 10 N2 - OBJECTIVE: The clinical characteristics of patients with relapsing anti-NMDA receptor (NMDAR) encephalitis are not well-defined. In this study, we report the clinical profile and outcome of relapses in a series of anti-NMDAR encephalitis. METHODS: We did a retrospective review of relapses that occurred in 25 patients with anti-NMDAR encephalitis. Relapses were defined as any new psychiatric or neurologic syndrome, not explained by other causes, which improved after immunotherapy or, less frequently, spontaneously. RESULTS: A total of 13 relapses were identified in 6 patients. Four of them had several, 2 to 4, relapses. There was a median delay of 2 years (range 0.5 to 13 years) for the first relapse. Median relapse rate was 0.52 relapses/patient-year. Relapse risk was higher in patients who did not receive immunotherapy in the first episode (p = 0.009). Most cases (53%) presented partial syndromes of the typical anti-NMDAR encephalitis. Main symptoms of relapses were speech dysfunction (61%), psychiatric (54%), consciousness-attention disturbance (38%), and seizures (31%). Three relapses (23%) presented with isolated atypical symptoms suggestive of brainstem-cerebellar involvement. An ovarian teratoma was detected at relapse in only 1 patient (17%). Relapses did not add residual deficit to that caused by the first episode. CONCLUSIONS: Relapses in anti-NMDAR encephalitis are common (24%). They may occur many years after the initial episode. Relapses may present with partial aspects or with isolated symptoms of the full-blown syndrome. Immunotherapy at first episode reduces the risk of relapses. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/21865579/Analysis_of_relapses_in_anti_NMDAR_encephalitis_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=21865579 DB - PRIME DP - Unbound Medicine ER -