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Neuropsychiatric phenotypes of anti-NMDAR encephalitis: a prospective study.

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Title: Neuropsychiatric phenotypes of anti-NMDAR encephalitis: a prospective study.
Authors: Espinola-Nadurille, M., Restrepo-Martínez, M., Bayliss, L., Flores-Montes, E., Rivas-Alonso, V., Vargas-Cañas, S., Hernández, L., Martínez-Juarez, I., Gonzalez-Aguilar, A., Solis-Vivanco, R., Fricchione, G. L., Flores-Rivera, J., Ramirez-Bermudez, J.
Source: Psychological Medicine. Jul2023, Vol. 53 Issue 9, p4266-4274. 9p.
Subjects: Cognition disorder risk factors, Mental illness risk factors, Mental depression risk factors, Immunoglobulins, Immunohistochemistry, Multivariate analysis, Psychoses, Movement disorders, Risk assessment, Functional assessment, Catatonia, Anti-NMDA receptor encephalitis, Descriptive statistics, Delirium, Research funding, Cerebrospinal fluid, Anxiety, Seizures (Medicine), Phenotypes, Longitudinal method, Mania, Comorbidity, Disease risk factors, Disease complications
Geographic Terms: Mexico
Abstract: Background: Patients with anti- N -methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) show a wide range of behavioral abnormalities and are often mistaken for primary psychiatric presentations. We aimed to determine the behavioral hallmarks of ANMDARE with the use of systematic neuropsychiatric and cognitive assessments. Methods: A prospective study was conducted, with 160 patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis and/or red flags along a time window of seven years. Cerebrospinal fluid (CSF) antibodies against the NR1 subunit of the NMDAR were processed with rat brain immunohistochemistry and cell-based assays with NMDA expressing cells. Systematic cognitive, neuropsychiatric, and functional assessments were conducted before knowing NMDAR antibodies results. A multivariate analysis was used to compare patients with and without definite ANMDARE according to antibodies in CSF. Results: After obtaining the CSF antibodies results in 160 consecutive cases, 100 patients were positive and classified as having definite ANMDARE. The most frequent neuropsychiatric patterns were psychosis (81%), delirium (75%), catatonia (69%), anxiety-depression (65%), and mania (27%). Cognition was significantly impaired. A total of 34% of the patients had a predominantly neuropsychiatric presentation without seizures. After multivariate analysis, the clinical hallmarks of ANMDARE consisted of a catatonia–delirium comorbidity, tonic-clonic seizures, and orolingual dyskinesia. Conclusions: Our study supports the notion of a neurobehavioral phenotype of ANMDARE characterized by a fluctuating course with psychotic and affective symptoms, catatonic signs, and global cognitive dysfunction, often accompanied by seizures and dyskinesia. The catatonia–delirium comorbidity could be a distinctive neurobehavioral phenotype of ANMDARE. [ABSTRACT FROM AUTHOR]
Copyright of Psychological Medicine is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Neuropsychiatric phenotypes of anti-NMDAR encephalitis: a prospective study.
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  Data: <searchLink fieldCode="AR" term="%22Espinola-Nadurille%2C+M%2E%22">Espinola-Nadurille, M.</searchLink><br /><searchLink fieldCode="AR" term="%22Restrepo-Martínez%2C+M%2E%22">Restrepo-Martínez, M.</searchLink><br /><searchLink fieldCode="AR" term="%22Bayliss%2C+L%2E%22">Bayliss, L.</searchLink><br /><searchLink fieldCode="AR" term="%22Flores-Montes%2C+E%2E%22">Flores-Montes, E.</searchLink><br /><searchLink fieldCode="AR" term="%22Rivas-Alonso%2C+V%2E%22">Rivas-Alonso, V.</searchLink><br /><searchLink fieldCode="AR" term="%22Vargas-Cañas%2C+S%2E%22">Vargas-Cañas, S.</searchLink><br /><searchLink fieldCode="AR" term="%22Hernández%2C+L%2E%22">Hernández, L.</searchLink><br /><searchLink fieldCode="AR" term="%22Martínez-Juarez%2C+I%2E%22">Martínez-Juarez, I.</searchLink><br /><searchLink fieldCode="AR" term="%22Gonzalez-Aguilar%2C+A%2E%22">Gonzalez-Aguilar, A.</searchLink><br /><searchLink fieldCode="AR" term="%22Solis-Vivanco%2C+R%2E%22">Solis-Vivanco, R.</searchLink><br /><searchLink fieldCode="AR" term="%22Fricchione%2C+G%2E+L%2E%22">Fricchione, G. L.</searchLink><br /><searchLink fieldCode="AR" term="%22Flores-Rivera%2C+J%2E%22">Flores-Rivera, J.</searchLink><br /><searchLink fieldCode="AR" term="%22Ramirez-Bermudez%2C+J%2E%22">Ramirez-Bermudez, J.</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Mexico%22">Mexico</searchLink>
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  Data: Background: Patients with anti- N -methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) show a wide range of behavioral abnormalities and are often mistaken for primary psychiatric presentations. We aimed to determine the behavioral hallmarks of ANMDARE with the use of systematic neuropsychiatric and cognitive assessments. Methods: A prospective study was conducted, with 160 patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis and/or red flags along a time window of seven years. Cerebrospinal fluid (CSF) antibodies against the NR1 subunit of the NMDAR were processed with rat brain immunohistochemistry and cell-based assays with NMDA expressing cells. Systematic cognitive, neuropsychiatric, and functional assessments were conducted before knowing NMDAR antibodies results. A multivariate analysis was used to compare patients with and without definite ANMDARE according to antibodies in CSF. Results: After obtaining the CSF antibodies results in 160 consecutive cases, 100 patients were positive and classified as having definite ANMDARE. The most frequent neuropsychiatric patterns were psychosis (81%), delirium (75%), catatonia (69%), anxiety-depression (65%), and mania (27%). Cognition was significantly impaired. A total of 34% of the patients had a predominantly neuropsychiatric presentation without seizures. After multivariate analysis, the clinical hallmarks of ANMDARE consisted of a catatonia–delirium comorbidity, tonic-clonic seizures, and orolingual dyskinesia. Conclusions: Our study supports the notion of a neurobehavioral phenotype of ANMDARE characterized by a fluctuating course with psychotic and affective symptoms, catatonic signs, and global cognitive dysfunction, often accompanied by seizures and dyskinesia. The catatonia–delirium comorbidity could be a distinctive neurobehavioral phenotype of ANMDARE. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Psychological Medicine is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1017/S0033291722001027
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        Text: English
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