Encephalatrophy and anti-N-methyl-D-aspartate receptor encephalitis

Abstract Objective: This study aims to find whether there are differences of clinical and laboratory features between anti-NMDAR encephalitis patients with and without brain atrophy. We also compare brain atrophy scale in anti-NMDAR positive patients with and without teratomas. Methods: Brain atrophy scales of 82 patients with anti-NMDAR encephalitis were measured with the median temporal lobe atrophy (MTA) scale and the global cortical atrophy (GCA) scale. They were divided into two groups by brain atrophy status. In addition, 48 female patients with anti-NMDAR encephalitis were divided into two groups with or without teratomas. Percentages of patients with brain atrophy were compared between these two groups. Results: 33 (40.2%) patients had brain atrophy. The GCA (+) group had higher percentage of patients with status epilepticus (p<0.001) than GCA (-) group and the MTA (+) group had higher percentage of patients with memory deficits (p < 0.001) than MTA (-) group. Higher percentages of severe infections were found in GCA(+) and MTA (+) groups than those in GCA(-) and MTA (-) groups (p=0.01 and p = 0.002, respectively). The percentage of patients needing ventilatory support was higher in MTA (+) group than that in MTA (-) group (p=0.015). The modified Rankin Scale (mRS) scores of GCA(+) and MTA (+) groups were significantly higher when compared with GCA(-) and MTA (-) groups both at day one (p<0.001 and p=0.001, respectively) and at discharge (p<0.001 and p = 0.02, respectively). Patients in GCA (+) group had higher median length of hospital stay than those in GCA (-) group (p<0.001). The median onset-to-MR time of GCA(+) group was higher than that of GCA(-) group (p=0.034). Percentage of patients with limited response to treatment was higher in GCA (+) group than that in GCA(-) group (p<0.001). The median 25 hydroxyvitamin D3 level was lower in the GCA (+) group than that in GCA(-) group (p=0.001). Anti-NMDAR positive female patients with ovarian teratomas had higher percentage of GCA(+) than thoes without ovarian teratomas (P=0.006). Conclusions: Brain atrophy are not uncommon in patients with anti-NMDAR encephalitis. MTA and GCA may be associated with severity and prognosis of anti-NMDAR encephalitis.