Anti-N-methyl-D-aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care.
Am J Respir Crit Care Med. 2016 Aug 23;
Authors: de Montmollin É, Demeret S, Brulé N, Conrad M, Dailler F, Lerolle N, Navellou JC, Schwebel C, Alves M, Cour M, Engrand N, Tonnelier JM, Maury E, Ruckly S, Picard G, Rogemond V, Magalhaes É, Sharshar T, Timsit JF, Honnorat J, Sonneville R, ENCEPHALITICA study group
RATIONALE: Encephalitis due to anti-N-methyl-D-aspartate receptor (NMDAR) antibodies is the leading cause of immune-mediated encephalitis. There is limited data on intensive care unit (ICU) management of these patients.
OBJECTIVES: To identify prognostic factors of good neurologic outcome in patients admitted to an ICU with anti-NMDAR encephalitis.
METHODS: Observational multicenter study of all consecutive adult patients diagnosed with anti-NMDAR encephalitis, admitted to an ICU between 2008 and 2014. The primary outcome was a good neurologic outcome at 6 months after ICU admission, defined by a modified Rankin scale score of 0 to 2.
MEASUREMENTS AND MAIN RESULTS: Seventy-seven patients were included from 52 ICUs. First-line immunotherapy consisted of steroids (n=61/74, 82%), intravenous immunoglobulins (n=71/74, 96%) and plasmapheresis (n=17/74, 23%). Forty-five (61%) patients received second-line immunotherapy (cyclophosphamide, rituximab or both). At 6 months, 57% of patients had a good neurologic outcome. Independent factors of good neurologic outcome were early (≤8 days following ICU admission) immunotherapy (OR 16.16, 95% CI (3.32-78.64) for combined first-line immunotherapy with steroids and intravenous immunoglobulins versus late immunotherapy), and a low white blood cell count on the first CSF examination (OR 9.83 for <5 versus >50 cells/mm3, 95% CI (1.07-90.65)). Presence of non-neurologic organ failures at ICU admission and occurrence of status epilepticus during ICU stay were not associated with neurologic outcome.
CONCLUSIONS: The prognosis of adult patients with anti-NMDAR encephalitis requiring intensive care is good, especially when immunotherapy is initiated early, advocating for prompt diagnosis and early aggressive treatment.
PMID: 27552490 [PubMed - as supplied by publisher]