A score that predicts 1-year functional status in patients with anti-NMDA receptor encephalitis.

Abstract

OBJECTIVE:

To construct a grading score that predicts neurologic function 1 year after diagnosis of anti-NMDA receptor (NMDAR) encephalitis.

METHODS:

Three 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.

RESULTS:

Intensive 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/μL 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).

CONCLUSIONS:

The 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.

• Authors: Ramani Balu, Lindsey McCracken, Eric Lancaster, Francesc Graus, Josep Dalmau, Maarten J Titulaer
• Journal: Neurology (Neurology) Vol. 92 Issue 3 Pg. e244-e252 (01 15 2019) ISSN: 1526-632X [Electronic] United States
• PMID: 30578370 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-N-Methyl-D-Aspartate Receptor Encephalitis (diagnosis, genetics, physiopathology)
• Child
• Child, Preschool
• Electroencephalography
• Female
• Follow-Up Studies
• Humans
• Infant
• Logistic Models
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Movement Disorders (etiology)
• Neurologic Examination
• Predictive Value of Tests
• Retrospective Studies
• Young Adult