好色先生

好色先生

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Abstract Details

Anti-NMDA Receptor Encephalitis in the Elderly Associates with Delays in Diagnosis, Treatment, and Worse Clinical outcome
Neuro-oncology
S35 - (-)
004
Anti-NMDAR encephalitis is a novel disease predominantly reported in young individuals. The manifestations of the disease in the elderly are unknown.
Cohort study, examining demographics, symptom onset, treatment, and long-term follow-up.
At symptom onset, 31 of 661 patients (5%) with anti-NMDAR encephalitis were older than 44 years. Fourteen (45%) were male compared with 12% in younger adults (18-44 year-old, p<0.001). Seven (23%) had an underlying tumor compared with 51% in younger adults (p=0.002). Only two patients had ovarian neoplasms (one teratoma, one stromal sex cord tumor); the other five had tumors of the breast, lung, or thymus. The most frequent initial symptoms were alterations of memory and behavior (16% and 58%, respectively). Median time to diagnosis and treatment was 7 weeks vs 4 weeks in younger adults (p=0.015). At presentation, the most common differential diagnoses included, limbic encephalitis, HSV or bacterial meningoencephalitis, leptomeningeal metastases, vasculitis, and Creutzfeldt-Jakob disease. Brain MRI was more frequently abnormal than in younger adults (53% vs 35%, p=0.049). The maximum severity of disease measured with the modified Rankin Scale (mRS) was lower in elder patients: 74% had mRS of 5 and 58% required ICU care, vs 87% and 80% in younger adults (p=0.056 and p=0.011, respectively). Despite the decreased severity of symptoms, outcome was worse in older patients: 64% had full or substantial recovery (mRS 0-2) at 24 months vs 81% in younger adults (p<0.05).
Anti-NMDA receptor encephalitis occurs less frequently in older adults, but it appears to be underdiagnosed. In patients older than 44 years, there is less predominance of women and the tumors are more diverse. The recognition of the disorder in this age group is less suspected leading to delay in diagnosis, treatment, and worse outcome.
Authors/Disclosures
Maarten J. Titulaer, MD, PhD (Erasmus Medical Center)
PRESENTER 		The institution of Dr. Titulaer has received research support from Dutch Epilepsy Foundations (NEF 19-08). The institution of Dr. Titulaer has received research support from CSL Behring. The institution of Dr. Titulaer has received research support from UCB. The institution of Dr. Titulaer has received research support from Netherlands Organisation for Scientific Research (ZonMW, Memorabel initiative and E-RARE UltraAIE) . The institution of Dr. Titulaer has received research support from Horizon Therapeutics / Amgen. The institution of Dr. Titulaer has received research support from Dioraphte (charity). The institution of Dr. Titulaer has received research support from Guidepoint Global LLC. The institution of Dr. Titulaer has received research support from ArgenX. Dr. Titulaer has received publishing royalties from a publication relating to health care.
Lindsey McCracken (University of Pennsylvania) No disclosure on file
No disclosure on file
Takahiro Iizuka, MD (Department of Neurology, Kitasato University School of Medicine) The institution of Dr. Iizuka has received research support from EUROIMMUN Japan Co., Ltd.
Izumi Kawachi, MD, PhD (Niigata University) Dr. Kawachi has received personal compensation in the range of $0-$499 for serving as a Consultant for Mochida Pharmaceutical CO., LTD.. Dr. Kawachi has received personal compensation in the range of $0-$499 for serving as a Consultant for Euroimmune. Dr. Kawachi has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Chugai Pharmaceuticals. Dr. Kawachi has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Mitsubishi Tanabe Pharma. Dr. Kawachi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Chugai Pharmaceuticals. Dr. Kawachi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis Pharma. Dr. Kawachi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Kawachi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion Pharmaceuticals. Dr. Kawachi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Mitsubishi Tanabe Pharma. Dr. Kawachi has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Argenx. Dr. Kawachi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. Dr. Kawachi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Daiichi-Sankyo. Dr. Kawachi has received research support from JSPS KAKENHI. Dr. Kawachi has received research support from MHLW Research Program on Rare and Intractable Diseases. Dr. Kawachi has received research support from Japan Kampo Medicine 好色先生 Foundation.
Myrna R. Rosenfeld, MD, PhD, FAAN (University of Barcelona) Dr. Rosenfeld has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. An immediate family member of Dr. Rosenfeld has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生. Dr. Rosenfeld has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Lamson Dugan & Murray LLP. The institution of an immediate family member of Dr. Rosenfeld has received research support from Sage Therapeutics. The institution of an immediate family member of Dr. Rosenfeld has received research support from Edmond J. Safra Foundation. The institution of an immediate family member of Dr. Rosenfeld has received research support from La Caixa Foundation. The institution of an immediate family member of Dr. Rosenfeld has received research support from Spanish Ministry of Health. The institution of an immediate family member of Dr. Rosenfeld has received research support from Department of Health, Government of Catalunya. Dr. Rosenfeld has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Rosenfeld has received intellectual property interests from a discovery or technology relating to health care. Dr. Rosenfeld has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Rosenfeld has received intellectual property interests from a discovery or technology relating to health care. Dr. Rosenfeld has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Rosenfeld has received publishing royalties from a publication relating to health care. Dr. Rosenfeld has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Rosenfeld has received publishing royalties from a publication relating to health care.
Rita Balice-Gordon, PhD (Muna Therapeutics) No disclosure on file
Francesc R. Graus, MD (IDIBAPS) Dr. Graus has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink. Dr. Graus has received intellectual property interests from a discovery or technology relating to health care.
Josep O. Dalmau, MD, PhD, FAAN Dr. Dalmau has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astellas Research Institute of America. Dr. Dalmau has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen Research & Development . Dr. Dalmau has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生. An immediate family member of Dr. Dalmau has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Dalmau has received research support from Sage Therapeutics. The institution of Dr. Dalmau has received research support from Edmond J.Safra Foundation . The institution of Dr. Dalmau has received research support from La Caixa Foundation. The institution of Dr. Dalmau has received research support from Spanish Ministry of Health (ISCIII). The institution of Dr. Dalmau has received research support from Euroimmun, Inc. Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. Dr. Dalmau has received publishing royalties from a publication relating to health care. Dr. Dalmau has received publishing royalties from a publication relating to health care. Dr. Dalmau has received publishing royalties from a publication relating to health care.
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit) Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.