Analysis of relapses in anti-NMDAR encephalitis
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 aspec…
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The lower frequency of neurological relapses (12% versus 20-24% reported in previous studies) is likely due to better recognition of the disorder, earlier treatment, and increasing use of second-line immunotherapy.
“The lower frequency of neurological relapses (12% versus 20-24% reported in previous studies)11, 18 is likely due to better recognition of the disorder, earlier treatment, and increasing use of second-line immunotherapy.”
From Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study (2013) · cites this paper as [18]
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Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies
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Dalmau, J., Tüzün, E., Wu, H., Masjuan, J., Rossi, J. E., Voloschin, A., Baehring, J. M., Shimazaki, H., Koide, R., King, D., et al. (2007) · Annals of Neurology · doi:10.1002/ana.21050 · Cited by 2,492 · see citing works
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Titulaer, M. J., McCracken, L., Gabilondo, I., Armangué, T., Glaser, C., Iizuka, T., Honig, L. S., Benseler, S. M., Kawachi, I., Martinez-Hernandez, E., et al. (2013) · The Lancet Neurology · doi:10.1016/s1474-4422(12)70310-1 · Cited by 3,165 · see citing works
Self-citationNeuroinflammation and psychiatric illness
Najjar, S., Pearlman, D. M., Alper, K., Najjar, A., & Devinsky, O. (2013) · Journal of Neuroinflammation · doi:10.1186/1742-2094-10-43 · Cited by 733 · see citing works
- Authors
- 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.
- Affiliations
- Hospital Clínico San Carlos (ES)
- Venue
- Neurology
- Published
- 2011-09-06
- Volume
- 77
- Issue
- 10
- Pages
- 996-999
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2117091873
- Cited by
- 264
- References
- 2
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 15 · 2023: 17 · 2022: 21 · 2021: 27 · 2020: 16 · 2019: 24 · 2018: 21 · 2017: 16 · 2016: 16 · 2015: 18 · 2014: 7 · 2013: 19 · 2012: 20
- FWCI
- 8.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Keywords
- anti-NMDA receptor encephalitis, relapse, immunotherapy, relapse risk, speech dysfunction, psychiatric symptoms, seizures, ovarian teratoma, autoimmune encephalitis, clinical outcomes
- MeSH terms
- Adolescent, Adult, Autoantibodies, Child, Child, Preschool, Encephalitis, Female, Follow-Up Studies, Humans, Immunotherapy, Infant, Male, Middle Aged, Recurrence, Retrospective Studies, Receptors, N-Methyl-D-Aspartate, Young Adult, HEK293 Cells
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