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Characterisation and outcome of neuropsychiatric symptoms in patients with anti-NMDAR encephalitis

Published online by Cambridge University Press:  20 January 2020

Miguel Restrepo-Martinez Open the ORCID record for Miguel Restrepo-Martinez [Opens in a new window] ,
Jesus Ramirez-Bermudez Open the ORCID record for Jesus Ramirez-Bermudez [Opens in a new window] ,
Leo Bayliss  and
Mariana Espinola-Nadurille
Miguel Restrepo-Martinez
Affiliation:
Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
Jesus Ramirez-Bermudez
Affiliation:
Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
Leo Bayliss
Affiliation:
Department of Neuropsychiatry and Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
Mariana Espinola-Nadurille*
Affiliation:
Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico Department of neurology and neurosurgery, Médica Sur, Mexico
*
Author for correspondence: Mariana Espinola-Nadurille, Email: [email protected]
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Abstract

Background:

Encephalitis due to anti-N-methyl-D-aspartate receptor antibodies (ANMDARE) is the most frequent immune-mediated encephalitis. It is distinguished by the subacute onset of neuropsychiatric symptoms.

Objective:

To evaluate the characteristic neuropsychiatric symptoms and their outcome in patients diagnosed with ANMDARE.

Methods:

This was a prospective, longitudinal study in patients with a diagnostic suspicion of ANMDARE that presented to the National Institute of Neurology from March 2018 to February 2019. A comparative analysis of two groups (positive N-methyl-D-aspartate receptor [NMDAR] vs. negative NMDAR antibodies in cerebrospinal fluid [CSF]) was done on admission and at discharge. Neuropsychiatric systematic assessments included the Neuropsychiatric Inventory Questionnaire, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method Severity, the Montreal Cognitive Assessment, and the Overt Agitation Severity Scale.

Results:

24 individuals were analysed: 14 had positive NMDAR antibodies, and 10 had negative NMDAR antibodies in CSF. On admission, agitation/aggression, euphoria/exaltation, and disinhibition were more common in patients with positive antibodies. Excited catatonia and delirium were diagnosed more frequently in patients with positive antibodies. At discharge, there was an important decrease in neuropsychiatric symptoms, but substantial cognitive impairment remained. The mean hospitalisation length was 41.71 (SD 39.33) days for patients with definitive ANMDARE (p 0.259).

Conclusions:

Neuropsychiatric symptoms profile in ANMDARE was associated with the early onset of euphoria/exaltation and disinhibition, accompanied by marked psychomotor agitation. When ANMDARE was suspected, the presence of excited-type catatonia and delirium showed a tendency to predict definitive ANMDARE. At discharged, most patients recovered from catatonia, delirium, and psychosis, but marked cognitive symptoms, anxiety, and depression persisted at discharge.

Keywords

anti-N-methyl-D-aspartate receptor encephalitisneuropsychiatrydifferentialdiagnosispsychoneuroimmunology
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 32 , Issue 2 , April 2020 , pp. 92 - 98
Copyright
© Scandinavian College of Neuropsychopharmacology 2020

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