Abstract
ObjectiveTo construct a grading score that predicts neurologic function 1 year after diagnosis of anti-NMDA receptor (NMDAR) encephalitis.MethodsThree hundred eighty-two patients with detailed information and functional status at 1 year were studied. Factors associated with poor status (defined as modified Rankin Scale score ≥3) were identified and incorporated into a multivariate logistic regression model. This model was used to develop a 5-point prediction score, termed the anti-NMDAR Encephalitis One-Year Functional Status (NEOS) score.ResultsIntensive care unit admission (p < 0.001), treatment delay >4 weeks (p = 0.012), lack of clinical improvement within 4 weeks (p < 0.001), movement disorder (p = 0.001), central hypoventilation (p < 0.001), elevated CSF white blood cell count (p < 0.001), elevated CSF protein level (p = 0.027), and abnormal MRI (p = 0.002) were associated with 1-year functional status in univariate analysis. Intensive care unit admission, treatment delay >4 weeks, lack of clinical improvement within 4 weeks, abnormal MRI, and CSF white blood cell count >20 cells/L were independent predictors for outcome in multivariate regression modeling. These 5 variables were assigned 1 point each to create the NEOS score. NEOS score strongly associated with the probability of poor functional status at 1 year (3% for 0 or 1 point to 69% for 4 or 5 points, p < 0.001).ConclusionsThe NEOS score accurately predicts 1-year functional status in patients with anti-NMDAR encephalitis. This score could help estimate the clinical course following diagnosis and may aid in identifying patients who could benefit from novel therapies.
| Original language | English |
|---|---|
| Pages (from-to) | E244-E252 |
| Journal | Neurology |
| Volume | 92 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 15 Jan 2019 |
Bibliographical note
Funding Information:This study was supported in part by Instituto Carlos III/ FEDER (FIS PI15/00377 [F.G.]; FIS PI14/00203 [J.D.]); CIBERER CB15/00010 (J.D.); NIH RO1NS077851 (J.D.); NIH K08 NS-075142-01A1 (E.L.); Fundació CELLEX (J.D.); Dutch Epilepsy Foundation (NEF, project 14-19 [M.T.]); and Netherlands Organisation for Scientific Research (NWO/ZonMW, Memorabel program and Veni incentive [M.T.]).
Funding Information:
R. Balu and L. McCracken report no disclosures relevant to the manuscript. E. Lancaster has consulted for Grifols Inc., Novartis Inc., and Merck Inc., and received a research grant from Grifols Inc. F. Graus receives royalties from EURO-IMMUN AG for the use of IgLON5 as an autoantibody test. J. Dalmau receives royalties from Athena Diagnostics for the use of Ma-2 as an autoantibody test and from EUROIMMUN AG for the use of NMDA, GABAB receptor, GABAA receptor, DPPX, and IgLON5 as autoantibody tests; he received an unrestricted research grant from EUROIMMUN AG. M. Titulaer has a patent for testing of anti-GABABR and anti-KCTD antibodies, and has received research funds for serving on a scientific advisory board of MedImmune LLC, for consultation at Guidepoint Global LLC, and an unrestricted research grant from EUROIMMUN AG. Go to Neurology.org/ N for full disclosures.
Funding Information:
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. The Article Processing Charge was funded by Erasmus University.
Publisher Copyright:
© American Academy of Neurology 2018.