Abstract Details

Title Female Reproductive Impact of Treatment for Anti-N-methyl-D-aspartate Receptor (NMDAR) Encephalitis

Topic Autoimmune Neurology

Presentation(s) N6 - Neuroscience in the Clinic: The Brain Across the Menstrual Cycle (4:50 PM-5:05 PM)

Poster/Presentation
Number 002

Objective To characterize the female reproductive impact of treatment of NMDAR encephalitis.

Background NMDAR encephalitis predominantly affects young women. Currently used treatments include corticosteroids, intravenous immunoglobulin, plasma exchange, rituximab, cyclophosphamide, and mycophenolate mofetil. Surgical options include oophorectomy for teratoma removal. These treatments can impact patients’ future reproductive capabilities, and patients are often unable to participate in medical decision-making because of their symptoms. As such, these treatment modalities may cause real or perceived unintended consequences affecting patients’ later family-planning decisions.

Design/Methods

Patients with NMDAR antibodies and a clinical diagnosis of encephalitis at the Massachusetts General Hospital (2010-2018) were identified. Patients were contacted by telephone in 2018 and administered a structured questionnaire exploring family planning considerations at the time of initial treatment and subsequent reproductive course.

Results

Of 24 cases identified, 19 (79%) were female and 13 (54%) were between ages 16-45 years. 22 patients (92%) were unable to give consent for their initial treatment. Presenting symptoms included catatonia, mutism, aphasia, hallucinations, delusions, and coma. In three cases (13%), legal guardianship was obtained prior to intervention, and in 2 cases (8%), the ethics committee was involved prior to intervention. In three cases (13%), no surrogate decision-maker was documented. 16 women (67%) were nulliparous at diagnosis. Ten women (52%) were diagnosed with an ovarian teratoma or other gynecological tumor; all underwent surgical resection. Five women (26%) received cyclophosphamide as part of their initial therapy. 13 women (68%) intended to have children in the future, of whom four (31%) have attempted conception since initial treatment, and two (15%) had uncomplicated pregnancies.

Conclusions These cases highlight the urgent need for formal guidelines standardizing the documentation and counseling offered prior to the administration of potentially fertility-limiting therapies for reversibly incapacitated patients. They also represent a burgeoning new neuro-gynecological interface that requires further deliberation and characterization.

Authors/Disclosures
Pria Anand, MD (Boston University School of Medicine) PRESENTER	Dr. Anand has nothing to disclose.
	No disclosure on file
Nagagopal Venna, MBBS, FAAN (Massachusetts General Hospital)	Dr. Venna has nothing to disclose.
Tracey Cho, MD, FAAN	Dr. Cho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyverna. Dr. Cho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Delve Bio. Dr. Cho has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of an immediate family member of Dr. Cho has received research support from NIH. Dr. Cho has received publishing royalties from a publication relating to health care.
Jenny Linnoila, MD, PhD (University Neurology Associates, UPMC)	Dr. Linnoila has received personal compensation in the range of $10,000-$49,999 for serving as a expert respondent on autoimmune encephalitis with U.S. government/DHHS/Vaccine Injury Compensation Program.
Farrah J. Mateen, MD, PhD, FAAN (Northwestern University Department of Neurology)	Dr. Mateen has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Mateen has received research support from Genentech. The institution of Dr. Mateen has received research support from Amgen. The institution of Dr. Mateen has received research support from TG Therapeutics. Dr. Mateen has received intellectual property interests from a discovery or technology relating to health care.

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