Diagnosis status and epidemiological characteristics of Anti-N-methyl-D-aspartate receptor encephalitis in Sichuan province_Journal of Epilepsy

Authors：

GUO Yonghua ^1,2 , ZUO Xiaoli ¹ , XU Anjing ³ , DENG Xiaojuan ⁴ , DENG Yan ⁵ , LIU Yong ⁶ , YAN ZiJun ⁷ , ZHANG Yang ⁸ , XIONG Yi ¹ , ZHOU Jing ¹ , ZHOU Dong ² ,  HONG Zhen ²

1. Department of Neurology, Leshan people's hospital, Leshan 614000, China;
2. Department of Neurology, West China Hospital, Chengdu 610041, China;
3. Department of Pharmacy, Leshan people's hospital, Leshan 614000, China;
4. Department of Outpatient, Sichuan Province People's Hospital, Chengdu 610041, China;
5. Department of Pediatrics, Affiliated Hospital, Southwest Medical University, Luzhou 646000, China;
6. Department of Neurology, Deyang People's Hospital, Deyang 618000, China;
7. Department of Pharmacy, Panzhihua People's Hospital, Panzhihua 617000, China;
8. Department of the second surgery, Mianzhu People's Hospital, Mianzhu 618200, China;

Corresponding?author：

HONG Zhen, Email: 45713152@qq.com

Keywords：

Anti-N-methyl-D-aspartate receptor encephalitis; Sichuan province; Diagnosis status; Epidemiology

DOI：

10.7507/2096-0247.20170057

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Objective To analyze the diagnosis status and epidemiological characteristics of anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR encephalitis) in the Sichuan province of China. Methods In the retrospective survey study, data of cases suspected as autoimmune encephalitis in Sichuan province from January 2012 to February 2017 were collected from the third-party test center.The diagnosis status and epidemiological characteristics of anti-NMDAR encephalitis were analyzed. Results ① A total of 1 714 cases had been suspected as autoimmune encephalitis with anti NMDA receptor antibodies tested.In hospitals of capital city, cerebrospinal fluid or serum of 1 511 cases were tested since 2012.In other cities, 203 cases were tested since 2014.Hospitals with anti NMDA receptor antibodies tested increased by year.The cases distributed in the department of neurology, psychology, pychiatric, ICU, pediatrics, geriatrics, otolaryngology, infection, the mergency department and pneumology.② Cases with anti NMDA receptor antibodies tested increased by year.A total of 155 cases were confirmed as anti-NMDAR encephalitis, with the average onset age of (27.9±12.0) years ranged from 9 years to 77 years, including 89 women and 66 male.The female average age were (26.5±11.31) years, while the male were(29.0±13.0) years.③ Among the 155 confirmed cases, 127 cases with detailed clinical data were analyzed further.Seizure and behavior disorder were the main symptoms at onset.Among the 127 cases, 107 cases were misdiagnosed at their first hospital visit, with the misdiagnose rate of 84.3%.18 cases were reported with tumors (17 female), mainly with teratoma(11/17). Conclusion In Sichuan province, the doctors of hospitals in non-capital city should strengthen the identification of autoimmune encephalitis.Anti-NMDAR encephalitis could be misdiagnosed easily and non-neurological physicians should also take attention;

Citation： GUO Yonghua, ZUO Xiaoli, XU Anjing, DENG Xiaojuan, DENG Yan, LIU Yong, YAN ZiJun, ZHANG Yang, XIONG Yi, ZHOU Jing, ZHOU Dong, HONG Zhen. Diagnosis status and epidemiological characteristics of Anti-N-methyl-D-aspartate receptor encephalitis in Sichuan province. Journal of Epilepsy, 2017, 3(5): 373-379. doi: 10.7507/2096-0247.20170057 Copy

1.	Vitaliani R, Mason W, Ances B, et al. Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma.Annals of Neurology, 2005, 58(4): 594-604.
2.	Dalmau J, Tüzün E, Wu HY, et al. Paraneoplastic anti-Nmethyl-D-aspartate receptor encephalitis associated with ovarian teratoma.Ann Neurol, 2007, 61(1): 25-36.
3.	許春伶, 趙偉秦, 李繼梅, 等.抗N-甲基-D天冬氨酸受體腦炎一例.中華神經科雜志, 2010, 43(11): 781-783.
4.	W Wang, JM Li, FY Hu, et al. Anti-NMDA receptor encephalitis: clinical characteristics, predictors of outcome and the knowledge gap in southwest China.Eur J Neurol, 2016, 23(3): 621-629.
5.	Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis.Lancet Neurol, 2016, 15(4): 391-404.
6.	Wang Rui, Guan Hong Zhi, Ren Hai-Tao, et al. CSF findings in patients with anti-N-methyl-D-aspartate receptor-encephalitis.Seizure: the journal of the British Epilepsy Association, 2015, 29(4): 137-142.
7.	中華醫學會神經病學分會.中國自身免疫性腦炎診治專家共識.中華神經科雜志, 2017, 50(2): 91-98.
8.	Iizuka T, Sakai F, Ide T, et al.Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal.Neurology, 2008, 70(7): 504-511.
9.	Bayreuther C, Bourg V, Dellamoniea J, et al.Complex partial status epilepticus revealing anti-NMDA receptor encephalitis.Epileptic Disord, 2009, 11(3): 261-265.
10.	余金蓓, 王贊, 林衛紅.自身免疫性腦炎癲癇發作類型及腦電圖特點分析.癲癇雜志, 2016, 1(2): 132-138.
11.	劉潔, 羅向東, 陳杰, 等.自身免疫性腦炎腦電圖及誘發電位特點--附8例病例報告.癲癇雜志, 2017, 3(1): 33-38.
12.	Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study.Lancet Neurol, 2013, 12(2): 157-165.
13.	Sartori S, Nosadini M, Cesaroni E, et al. Paediatric anti-Nmethyl-D-aspartate receptor encephalitis: the first Italian multicenter case series.Eur J Paediatr Neurol, 2015, 19(4): 453-463.
14.	田青, 楊渝, 鮑健, 等.成年男性抗N-甲基-D-天冬氨酸受體腦炎的臨床特征分析.中華神經醫學雜志, 2016, 15(11): 1148-1153.
15.	趙力立, 羅蓉.兒童抗N-甲基-D-天冬氨酸受體腦炎3例報告.中國實用兒科雜志, 2016, 31(4): 315-317.
16.	張煒華, 王曉慧, 方方, 等.抗N-甲基-D-天冬氨酸受體腦炎102例臨床特征及隨訪.中國循證兒科雜志, 2016, 23(03): 182-186.
17.	Leypoldt F, Wandinger KP.Paraneoplastic neurological syndromes.Clin Exp Immunol, 2014, 175(3): 336-348.
18.	吳穎穎, 張杰文.抗N-甲基-D-天門冬氨酸受體腦炎與腫瘤關系的研究進展.中國神經免疫學和神經病學雜志, 2016, 16(02): 125-128.

1. Vitaliani R, Mason W, Ances B, et al. Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma.Annals of Neurology, 2005, 58(4): 594-604.
2. Dalmau J, Tüzün E, Wu HY, et al. Paraneoplastic anti-Nmethyl-D-aspartate receptor encephalitis associated with ovarian teratoma.Ann Neurol, 2007, 61(1): 25-36.
3. 許春伶, 趙偉秦, 李繼梅, 等.抗N-甲基-D天冬氨酸受體腦炎一例.中華神經科雜志, 2010, 43(11): 781-783.
4. W Wang, JM Li, FY Hu, et al. Anti-NMDA receptor encephalitis: clinical characteristics, predictors of outcome and the knowledge gap in southwest China.Eur J Neurol, 2016, 23(3): 621-629.
5. Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis.Lancet Neurol, 2016, 15(4): 391-404.
6. Wang Rui, Guan Hong Zhi, Ren Hai-Tao, et al. CSF findings in patients with anti-N-methyl-D-aspartate receptor-encephalitis.Seizure: the journal of the British Epilepsy Association, 2015, 29(4): 137-142.
7. 中華醫學會神經病學分會.中國自身免疫性腦炎診治專家共識.中華神經科雜志, 2017, 50(2): 91-98.
8. Iizuka T, Sakai F, Ide T, et al.Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal.Neurology, 2008, 70(7): 504-511.
9. Bayreuther C, Bourg V, Dellamoniea J, et al.Complex partial status epilepticus revealing anti-NMDA receptor encephalitis.Epileptic Disord, 2009, 11(3): 261-265.
10. 余金蓓, 王贊, 林衛紅.自身免疫性腦炎癲癇發作類型及腦電圖特點分析.癲癇雜志, 2016, 1(2): 132-138.
11. 劉潔, 羅向東, 陳杰, 等.自身免疫性腦炎腦電圖及誘發電位特點--附8例病例報告.癲癇雜志, 2017, 3(1): 33-38.
12. Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study.Lancet Neurol, 2013, 12(2): 157-165.
13. Sartori S, Nosadini M, Cesaroni E, et al. Paediatric anti-Nmethyl-D-aspartate receptor encephalitis: the first Italian multicenter case series.Eur J Paediatr Neurol, 2015, 19(4): 453-463.
14. 田青, 楊渝, 鮑健, 等.成年男性抗N-甲基-D-天冬氨酸受體腦炎的臨床特征分析.中華神經醫學雜志, 2016, 15(11): 1148-1153.
15. 趙力立, 羅蓉.兒童抗N-甲基-D-天冬氨酸受體腦炎3例報告.中國實用兒科雜志, 2016, 31(4): 315-317.
16. 張煒華, 王曉慧, 方方, 等.抗N-甲基-D-天冬氨酸受體腦炎102例臨床特征及隨訪.中國循證兒科雜志, 2016, 23(03): 182-186.
17. Leypoldt F, Wandinger KP.Paraneoplastic neurological syndromes.Clin Exp Immunol, 2014, 175(3): 336-348.
18. 吳穎穎, 張杰文.抗N-甲基-D-天門冬氨酸受體腦炎與腫瘤關系的研究進展.中國神經免疫學和神經病學雜志, 2016, 16(02): 125-128.

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