Abstract Details

Title A Case Series of Anti-NMDA Receptor Antibody Encephalitis: PET Images, EEG Findings, CSF Antibody Titers, Treatments and Outcomes

Topic Neurotoxicology

Presentation(s) P06 - (-)

Poster/Presentation
Number 197

Objective

Background BACKGROUND: Anti-NMDAR antibody encephalitis is an autoimmune disorder with a progressive course but the potential for recovery with appropriate treatment. Though prognosis is often favorable, clinical severity and response to treatment vary among individuals. Currently, there are no reliable biomarkers to predict treatment response.

Design/Methods DESIGN/METHODS: A multi-center, observational retrospective cohort review of clinical presentation, PET scan, EEG, CSF antibody titers, treatment course and outcomes.

Results RESULTS: : The patients were comprised of 8 women and 3 men. The median age of onset was 25 (range 19 - 62). Five out of 8 women had ovarian teratomas; no tumor was found in the 3 men. The most common presenting symptoms were abnormal behavior, seizure, movement disorder and dysautonomia. Median hospital length of stay was 60 days (range 20 - 270 d). PET scans were performed in 6 patients, showing 2 distinct patterns: 4 showed posterior hypometabolism in occipital lobes and cerebellum and 2 had normal metabolism. EEG recordings showed rhythmic or arrhythmic delta activities in 9 patients. Clinical recovery was achieved in 10 after immunotherapy and tumor resection. Persistent positive anti-NMDAR antibodies, either in CSF or serum, were found in 4 with prolonged hospital stay and refractory clinical course, 2 of which showed persistent elevation of CSF antibody titers.

Conclusions CONCLUSIONS: Although patients with anti-NMDAR encephalitis can recover after effective treatment, the clinical course varies among individuals. In our cohort, 4 severely affected patients with prolonged hospital stay showed persistently positive CSF antibodies, a posterior hypometabolism pattern or both. 18FDG-PET imaging and CSF antibody titers may be useful markers associated with clinical course and response to treatment.

Authors/Disclosures
Ning Zhong, MD (KP Medical Center) PRESENTER	Dr. Zhong has nothing to disclose.
Teddy S. Youn, MD (Barrow Neurological Institute)	Dr. Youn has nothing to disclose.
Arielle Davis, MD, FAAN (Harborview Medical Center)	Dr. Davis has nothing to disclose.
W. T. Longstreth, Jr., MD, FAAN (Harborview Medical Center)	The institution of Dr. Longstreth has received research support from NIH.
	No disclosure on file

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