Anti-N-methyl-D-aspartate receptor encephalitis: An observational and comparative study in Mexican children and adults

• Published in: Clinical neurology and neurosurgery 2021-11, Vol.210, p.106986-106986, Article 106986
• Main Authors: Herrera-Mora, Patricia, Munive-Baez, Leticia, Ruiz García, Matilde, Galindo-Martínez, Alfredo, Maldonado-Diaz, Daniela Ellis, Delgado, Rosa Delia, Cárdenas, Graciela
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adults; Age Factors; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - cerebrospinal fluid; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - diagnostic imaging; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - epidemiology; Anti-NMDA receptor antibodies; Antibodies; Autoimmune diseases; Catatonia; Cerebrospinal fluid; Child; Child, Preschool; Children; Children & youth; Comparative studies; Dyskinesia; Dystonia; Electroencephalography - methods; Encephalitis; Female; Fever; Follow-Up Studies; Gastroenteritis; Glutamate receptors; Glutamic acid receptors (ionotropic); Guardians; HEK293 Cells; Herpes viruses; Humans; Infections; Lability; Male; Medical imaging; Mexico - epidemiology; N-Methyl-D-aspartic acid receptors; Patients; Pediatrics; Population; Prodromal Symptoms; Respiratory tract diseases; Sex Factors; Tardive dyskinesia; Ultrasonic imaging; Viral infections; Young Adult
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2021.106986

To present a case series of encephalitis patients with anti-N-methyl-D-aspartate receptor antibodies, attending two neurological referral centers in a three-year period. A retrospective, descriptive, comparative study included child and adult patients in two neurological populations, positive for antibodies against the NR1 and NR2 subunits of the glutamate (NMDA) receptor in serum and CSF, as determined during a three-year period. Sixty-six patients were included (40 children and 26 adults). Male patients were more affected (M: F ratio was 1:0.6). No differences in progression or hospitalization time were observed between groups. In children, 35% of patients showed herpetic infection before autoimmune encephalitis (P = 0.01). Among viral prodromal symptoms, upper respiratory tract infection (P = 0.02) and fever (P = 0.001) predominated in children, while infectious gastroenteritis was more frequent in adults (P = 0.03). Among neuropsychiatric signs, mental confusion (P = 0.0001) and orofacial dyskinesia/oromandibular dystonia (P = 0.0001) were frequent in children, while emotional lability (P = 0.03), catatonia (P = 0.0001), and headache (P = 0.005) predominated in adults. The score in the modified Rankin scale on admission was higher in children (4.3 ± 0.8 vs. 2.2 ± 1.3, P = 0.0001), but at one-year of clinical follow up no significant differences were found. Male patients were predominantly affected in our population. One-third of all patients developed prodromal infection. Neuropsychiatric clinical complaints were different in children and adults. However, post-hospitalization recovery was similar between groups. •One-third of the total population developed prodromal infections.•During hospitalization, child patients presented a deeper functional commitment than adults.