Analysis of relapses in anti-NMDAR encephalitis
2011; Lippincott Williams & Wilkins; Volume: 77; Issue: 10 Linguagem: Inglês
10.1212/wnl.0b013e31822cfc6b
ISSN1526-632X
AutoresIñigo Gabilondo, Albert Saiz, Lisette Arias Galán, Vanesa Arbesú González, R. Jadraque, Lídia Sabater, A Sans, Amparo Sempere, A. Vela, F Villalobos, M. López Viñals, Pablo Villoslada, Francesc Graus,
Tópico(s)Polyomavirus and related diseases
ResumoObjective: 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.
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