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Status Epilepticus in Patients with Anti-NMDAR Encephalitis Requiring Intensive Care: A Follow-Up Study

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Abstract

Background

To date, specialized studies focusing on status epilepticus (SE) in anti-N-methyl d-aspartate receptor (anti-NMDAR) encephalitis are limited, and the association between the occurrence of SE and clinical outcome is controversial. This study aims to investigate the differences between patients with critical anti-NMDAR encephalitis with SE and patients who experienced epileptic seizures without SE and to evaluate the long-term disease outcomes of patients with anti-NMDAR encephalitis with SE who were admitted to the neurological intensive care unit (neuro-ICU).

Methods

In this retrospective study based on a prospective registry, patients with anti-NMDAR encephalitis with neuro-ICU admission from 2014 to 2019 were analyzed and divided into two groups based on whether they had SE. Their clinical characteristics during the neuro-ICU stay were assessed and compared. The neurological and seizure outcomes were evaluated every 3 months.

Results

Of 83 patients with anti-NMDAR encephalitis, 24 required intensive care. In the SE group, 38.5% (5 of 13) of patients developed refractory SE (RSE), and 21.3% (3 of 13) of patients developed super RSE. More patients in the SE group presented with seizures as the initial symptoms (53.8% vs. 9.1%, p = 0.033) and had a strong positive NMDAR antibody titer in the cerebrospinal fluid (76.9% vs. 27.3%, p = 0.043). More patients in the non-SE group had a good neurological outcome (modified Rankin Scale (mRS) score < 2) at 3 months after disease onset (60.0% vs. 15.4%, p = 0.039), but 83.3% of patients with SE had a mRS score < 2 at 9 months after disease onset, which was similar to the rate in the non-SE group. A total of 41.7% of patients with SE had their last seizure within 1 month from disease onset, which was significantly lower than the rate in the non-SE group (90%), but all the patients with SE became seizure free after the acute phase of disease.

Conclusions

Patients with critical anti-NMDAR encephalitis who present with SE have a high rate of RSE/super RSE and recover more slowly than patients without SE, but most of them will eventually achieve good long-term neurological outcomes and live seizure free after the acute phase.

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Acknowledgments

We thank all the staffs and patients who contributed to the study. In particular, we thank Dr. KH Chan (Associate Professor, Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong) for his valuable advice about this research and English writing.

Funding

This study was supported by the Funding Key Research and Development Project of Shaanxi Province (No.2020SF-306).

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Author notes

  1. Xuan Wang, Jian Wan and Zihan Wei have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi’an, 710032, Shaanxi Province, China

    Xuan Wang, Zihan Wei, Changgeng Song, Xiaogang Kang, Fang Du, Wen Jiang & Fang Yang

  2. State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi Province, China

    Jian Wan

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  1. Xuan Wang
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Contributions

Fang Yang and Wen Jiang designed the study. Xuan Wang, Jian Wan, and Zihan Wei collected the data. Jian Wan, Xuan Wang and Xiaogang Kang analyzed the data. Zihan Wei and Changgeng Song revised the statistical analyses. Xuan Wang and Jian Wan wrote the paper. Fang Yang, Fang Du and Wan Jiang revised the paper. All the authors approve the final version of the manuscript.

Corresponding authors

Correspondence to Wen Jiang or Fang Yang.

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The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Ethics Committee of Xijing Hospital, Fourth Military Medical University and was in compliance with the Helsinki Declaration.

Informed Consent

Informed consents for the current study were obtained from the patients or their guardians.

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Cite this article

Wang, X., Wan, J., Wei, Z. et al. Status Epilepticus in Patients with Anti-NMDAR Encephalitis Requiring Intensive Care: A Follow-Up Study. Neurocrit Care 36, 192–201 (2022). https://doi.org/10.1007/s12028-021-01283-4

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  • DOI: https://doi.org/10.1007/s12028-021-01283-4

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