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Abstract Details

Longitudinal clinical outcomes, cognitive impairment, and mood symptoms in anti-NMDAR encephalitis
Autoimmune Neurology
P5 - Poster Session 5 (11:45 AM-12:45 PM)
6-006

Outcomes in anti-NMDAR encephalitis are poorly understood but may be influenced by factors not adequately captured using the modified Rankin Scale (mRS).

To characterize longitudinal outcomes in anti-NMDA receptor (anti-NMDAR) encephalitis.

This retrospective, observational cohort study examined outcome measures (mRS and clinical assessment scale in autoimmune encephalitis, CASE) in adults with anti-NMDAR-IgG in CSF at hospital discharge and long-term follow-up. Linear and logistic regression modeled outcomes. Mixed models examined predictor effects by time. Subgroups with evaluations for cognitive impairment (CI) (Montreal Cognitive Assessment or Mini-Mental State Examination) >6 months from symptom onset and depression (Patient Health Questionnaire-9) and anxiety (General Anxiety Disorder-7) within 1 year of long-term follow-up were reported. Spearman correlations were examined between mood and final CASE scores.

Thirty-eight patients (76.3% female, median disease onset age=28 years, IQR=22-36) were included. The majority received first- (97.4%) and second-line (68.4%) immunosuppressants at a median of 3.9 weeks (IQR=2.1-9.7).

 

Median/mean mRS and CASE were 4 (IQR=3-5) and 12.7 (SD=7) at baseline and 2 (IQR=1-3) and 4 (SD=4.1) at long-term follow-up (median=70 weeks, IQR=51-174). Both improved from baseline (p<0.001).

 

At hospital discharge (median=10 weeks, IQR=6-17), predictors of higher CASE and mRS scores included: dysautonomia, coma/lethargy, seizures/status epilepticus, and intensive care unit admission (p<0.05).

 

At long-term follow-up, only onset weakness predicted higher mRS scores (OR=5.62, CI 1.02-30.90, p=0.047). Seizures were uncommon (3%). Psychiatric morbidity was the main contributor to final CASE scores (mean=1.3, SD=0.94).

 

In subgroup analyses, moderate-severe CI (50%), depression (29.5%), and anxiety (41.6%) were frequent. There was a correlation between depression (r=0.65, p<0.01) and anxiety (r=0.79, p<0.01) measures with final CASE memory sub-scores.

Different clinical factors predict early versus long-term outcomes in anti-NMDAR encephalitis. Only onset weakness predicts long-term disability by mRS. Long-term CI and mood symptoms were frequently noted. Highlighting a complex interplay, mood symptoms correlated with CASE memory sub-scores.
Authors/Disclosures
Annalisa Morgan, MD (Yale MS Center)
PRESENTER
Dr. Morgan has nothing to disclose.
Yadi Li Ms. Li has nothing to disclose.
Nicholas Thompson Nicholas Thompson has nothing to disclose.
Alexander D. Rae-Grant, MD, FAAN (Ebsco Information Services) Dr. Rae-Grant has received publishing royalties from a publication relating to health care. Dr. Rae-Grant has received publishing royalties from a publication relating to health care.
Justin Abbatemarco, MD (Cleveland Clinic Foundation) Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech . Dr. Abbatemarco has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics, Inc.. The institution of Dr. Abbatemarco has received research support from Horizon.
Vineet Punia, MD (Cleveland Clinic) Dr. Punia has nothing to disclose.
Stephen Hantus, MD (Cleveland Clinic) Dr. Hantus has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Hantus has received personal compensation in the range of $0-$499 for serving as a Consultant for UCB.
Rachel Galioto Rachel Galioto has nothing to disclose.
Amy Kunchok, MBBS (Cleveland Clinic - Mellen Centre) Dr. Kunchok has received personal compensation in the range of $0-$499 for serving as a Consultant for EMD Serono. Dr. Kunchok 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. Kunchok has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon therapeutics . Dr. Kunchok has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Kunchok 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 Neurology.