Le Zhang1, Xu Liu1, Xin-Yue Jiang1, Yun-Hui Wang1, Jin-Mei Li2, Dong Zhou3. 1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China. 2. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China. Electronic address: jinmeili-neuro@qq.com. 3. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China. Electronic address: zhoudong66@yahoo.de.
Abstract
PURPOSE: This study aimed to summarize the clinical characteristics and outcome of late-onset anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis in China. METHOD: All cases of people with a definitive diagnosis of anti-NMDAR encephalitis in West China Hospital between June 2012 and April 2017 were retrospectively reviewed. The demographics, clinical characteristics, and outcome of those patients (age≥45years old) were summarized. Comparisons were conducted between older (≥45years old) and younger (18-44years old) adults. RESULT: Eighteen (12%) of 151 people were ≥45years old, 9 of whom (50%) were female. Psychiatric symptoms were the most common clinical manifestations of older adults and presented in all individuals. At the last follow-up, 14 (78%) of them had a good outcome (modified Rankin Scale: 0-2) and one (6%) died. Compared with 121 younger adults, older adults had a higher proportion of presenting memory deficit as the initial symptom (17% vs. 2%, p=0.023), longer interval from onset to admission (30 vs. 13days, p=0.013), and longer interval from onset to diagnosis (42.5 vs. 24days, p=0.045). No older adults' condition was accompanied with teratoma compared with 75% of younger adults with tumor (p=0.032). And older adults had a tendency to have a lower rate of positive NMDAR antibody (Ab) in serum (28% vs. 52%, p=0.053). CONCLUSION: Delayed admission and diagnosis are more common in older adults than in younger adults. A comprehensive consideration of all symptoms and early screening of NMDAR Ab, especially in cerebrospinal fluid, is necessary and beneficial to differential diagnosis.
PURPOSE: This study aimed to summarize the clinical characteristics and outcome of late-onset anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis in China. METHOD: All cases of people with a definitive diagnosis of anti-NMDAR encephalitis in West China Hospital between June 2012 and April 2017 were retrospectively reviewed. The demographics, clinical characteristics, and outcome of those patients (age≥45years old) were summarized. Comparisons were conducted between older (≥45years old) and younger (18-44years old) adults. RESULT: Eighteen (12%) of 151 people were ≥45years old, 9 of whom (50%) were female. Psychiatric symptoms were the most common clinical manifestations of older adults and presented in all individuals. At the last follow-up, 14 (78%) of them had a good outcome (modified Rankin Scale: 0-2) and one (6%) died. Compared with 121 younger adults, older adults had a higher proportion of presenting memory deficit as the initial symptom (17% vs. 2%, p=0.023), longer interval from onset to admission (30 vs. 13days, p=0.013), and longer interval from onset to diagnosis (42.5 vs. 24days, p=0.045). No older adults' condition was accompanied with teratoma compared with 75% of younger adults with tumor (p=0.032). And older adults had a tendency to have a lower rate of positive NMDAR antibody (Ab) in serum (28% vs. 52%, p=0.053). CONCLUSION: Delayed admission and diagnosis are more common in older adults than in younger adults. A comprehensive consideration of all symptoms and early screening of NMDAR Ab, especially in cerebrospinal fluid, is necessary and beneficial to differential diagnosis.