Abbreviation (ISO4): Chinese Journal of Alzheimer's Disease and Related Disorders
Editor in chief: Jun WANG
Chinese Journal of Alzheimer's Disease and Related Disorders >
Analysis of clinical and cognitive characteristics of different types of autoimmune encephalitis in adults
Received date: 2021-05-14
Revised date: 2021-07-02
Online published: 2021-12-25
Objective: To analyze and compare clinical and cognitive characteristics of different types of autoimmune encephalitis in adults. Methods: By reviewing clinical data of 9 cases with different types of autoimmune encephalitis, including demographic data, clinical manifestations, MRI and EEG results, treatment and prognosis, and applying MMSE to assess the cognitive function in the acute and recovery phase,clinical and cognitive features of autoimmune encephalitis caused by different antibodies are analyzed and compared. Results: The main manifestations of 5 patients with anti-NMDAR encephalitis are mental symptoms, seizures, disturbance of consciousness, oro-facial dyskinesias or involuntary movements of limbs. One young woman with anti-NMDAR encephalitis presented hypoventilation, and had to get tracheotomy and mechanical ventilation, and ovarian teratoma was found through CT. 4 cases with limbic encephalitis presented cognitive impairment, mental symptoms, seizures and movement disorders. All patients responded well to immunotherapy, especially to seizures and movement disorders. MMSE in acute phase of anti-NMDAR encephalitis:(10.2±8.7), MMSE in recovery phase of anti-NMDAR encephalitis:(26.2±3.1),(P<0. 05); MMSE in acute phase of limbic encephalitis:(13.3±4.6), MMSE in recovery phase of limbic encephalitis:(16.0±7.0),(P>0. 05). Difference in MMSE between recovery phase and acute phase of anti-NMDAR encephalitis:(16.0±7.0), difference in MMSE between recovery phase and acute phase of limbic encephalitis:(6.3±4.1), (P<0. 05). Conclusion: Different kinds of autoimmune encephalitis have different clinical features, whereas, all are sensitive to immunotherapy. Both anti-NMDAR encephalitis and limbic encephalitis have obvious cognitive impairment in the acute stage, and get improved in the recovery stage. It seems that anti-NMDAR encephalitis has better cognitive recovery than limbic encephalitis.
LIU Li-ping , WANG Pan , ZHANG Miao , ZHOU Yu-ying . Analysis of clinical and cognitive characteristics of different types of autoimmune encephalitis in adults[J]. Chinese Journal of Alzheimer's Disease and Related Disorders, 2021 , 4(4) : 314 -318 . DOI: 10.3969/j.issn.2096-5516.2021.04.012
表1 临床表现及各症状在不同类型AE的出现率Tab.1 clinical manifestations and the incidence of various symptoms in different types of AE |
临床症状 | 抗NMDAR脑炎(n=5) | LE(n=4) |
---|---|---|
首发症状 | 3/5 发热; 2/5 癫痫发作 | 4/4 癫痫发作 |
认知损害 | 5/5 | 4/4 |
精神症状 | 5/5(3/5幻觉,3/5躁狂,1/5 攻击行为,1/5 秽语) | 4/4(2/4 幻觉) |
癫痫发作 | 4/5(4/5强直阵挛发作,2/5出现持续状态) | 4/4(3/4强直阵挛发作,1/4出现持续状态,1/4失神发作) |
运动症状(不自主运动或肌张力障碍) | 5/5(4/5不自主张口噘嘴,2/5对称肢体轮替动作, 1/5单侧肢体为主的不自主运动,1/5双手摸索) | 3/4(2/4 FBDS,1/4双手摸索) |
意识障碍 | 5/5(2/5癫痫发作时出现,1/5高热时出现) | 4/4(2/4癫痫发作时出现) |
其他症状 | 3/5 发热; 3/5 心律失常; 2/5 口腔分泌物增多; 1/5 中枢性低通气 | 1/4 发热; 1/4 低钠血症 |
表2 抗NMDAR脑炎与LE在急性期及恢复期的MMSE比较($\bar{x} \pm s$)Tab.2 MMSE comparison of anti-NMDAR encephalitis and LE in acute and recovery phase($\bar{x} \pm s$) |
类别 | 急性期MMSE(分) | 恢复期MMSE(分) | t值 | P值 |
---|---|---|---|---|
抗NMDAR脑炎(n=5) | 10.2±8.7 | 26.2±3.1 | -5.137 | 0.007 |
LE(n=4) | 13.3±4.6 | 20.5±9.3 | -2.728 | 0.072 |
AE(n=9) | 11.6±7.0 | 23.3±6.6 | -4.703 | 0.002 |
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