抗nmdar脑炎贯穿整个生命周期：来自拉丁美洲队列的临床、电生理和预后见解。

IF 2.5 4区医学 Q3 IMMUNOLOGY

Journal of neuroimmunology Pub Date : 2025-09-29 DOI:10.1016/j.jneuroim.2025.578766

Mariano Marrodan , Carolina I. Perez Arana , Ricardo J. Kirchner , Francisco J. Varela , Gabriela I. Orzuza , Angeles Schteinschnaider , Miriam G. Chaderevian , Cristina Vita , Mauricio F. Farez , Jorge Correale

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引用次数: 0

摘要

背景和目的：抗n -甲基-d-天冬氨酸受体脑炎（NMDARE）是最常见的自身免疫性脑炎，主要影响年轻女性。其临床异质性，特别是在代表性不足的人群中，给诊断和治疗带来了挑战。来自拉丁美洲的流行病学数据仍然有限。本研究旨在描述拉丁美洲高等教育中心NMDARE的人口统计学、临床和神经影像学特征，重点关注年龄相关差异。方法：回顾性队列研究纳入2016年1月至2024年12月的NMDARE病例。纳入标准要求CSF和/或血清中抗nmdar抗体阳性。系统地收集了人口统计学、临床和临床旁数据。结果：1026例筛查患者中，58例抗nmdar抗体检测呈阳性，49例符合纳入标准。女性在成人中的优势较高（61.5%比30.4%;p = 0.03）。成人更常表现为精神错乱（57.7%比13%，p = 0.003）、情绪障碍（61.5%比26.1%,p = 0.03）、认知障碍（76.9%比36.1%,p = 0.001）和自主神经障碍（19.2%比0%，p = 0.04）。言语障碍（56.5%比34.6%,p = 0.02）、运动障碍（56.5%比34.6%,p = 0.06）和脑电图异常（69.6%比42.3%,p = 0.01）在儿科患者中更为常见。脑脊液多细胞症与ICU入院独立相关（OR = 11, p = 0.01）。复发发生率为10%。讨论：在这个拉丁美洲队列中，NMDARE表现出不同的年龄依赖性临床特征。虽然现有的诊断标准广泛适用，但对年龄特异性特征的认识-特别是成人的精神症状和儿童的脑电图异常-可能提高诊断的准确性并指导量身定制的管理策略。在其他人群中进行的更大规模队列研究报告了不同的结果，强调了区域研究的重要性，以及需要进一步的研究来验证和推广这些结果。

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Anti-NMDAR encephalitis across the lifespan: Clinical, electrophysiological, and prognostic insights from a Latin American cohort

Background and objectives

Anti-N-Methyl-d-aspartate receptor encephalitis (NMDARE) is the most prevalent autoimmune encephalitis, primarily affecting young females. Its clinical heterogeneity, particularly in underrepresented populations, poses diagnostic and therapeutic challenges. Epidemiological data from Latin America remain limited. This study aimed to characterise the demographic, clinical, and neuroimaging features of NMDARE in Latin American tertiary centres, with a focus on age-related differences.

Methods

A retrospective cohort study included NMDARE cases between January 2016 and December 2024. Inclusion criteria required anti-NMDAR antibody positivity in CSF and/or serum. Demographic, clinical, and paraclinical data were systematically collected. Comparisons between paediatric (<18 years) and adult (≥18 years) patients were conducted using appropriate statistical tests.

Results

Of 1026 screened patients, 58 tested positive for anti-NMDAR antibodies, and 49 met inclusion criteria. Female predominance was higher among adults (61.5 % vs. 30.4 %; p = 0.03). Adults more frequently presented with confusion (57.7 % vs. 13 %; p = 0.003), mood disturbances (61.5 % vs. 26.1 %; p = 0.03), cognitive impairment (76.9 % vs. 36.1 %; p = 0.001), and dysautonomia (19.2 % vs. 0 %; p = 0.04). Speech disturbances (56.5 % vs. 34.6 %; p = 0.02), movement disorders (56.5 % vs 34.6 %, p = 0.06), and EEG abnormalities (69.6 % vs. 42.3 %; p = 0.01) were more frequent in paediatric patients. CSF pleocytosis was independently associated with ICU admission (OR = 11, p = 0.01). Relapse occurred in 10 % of cases.

Discussion

In this Latin American cohort, NMDARE presents distinct age-dependent clinical profiles. While existing diagnostic criteria are broadly applicable, awareness of age-specific features—particularly psychiatric symptoms in adults and EEG abnormalities in children—may improve diagnostic accuracy and guide tailored management strategies. Larger cohort studies in other populations have reported different findings, underscoring the importance of regional studies and the need for additional research to validate and generalize these results.

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来源期刊

Journal of neuroimmunology 医学-免疫学

CiteScore

6.10

自引率

3.00%

发文量

154

审稿时长

37 days

期刊介绍： The Journal of Neuroimmunology affords a forum for the publication of works applying immunologic methodology to the furtherance of the neurological sciences. Studies on all branches of the neurosciences, particularly fundamental and applied neurobiology, neurology, neuropathology, neurochemistry, neurovirology, neuroendocrinology, neuromuscular research, neuropharmacology and psychology, which involve either immunologic methodology (e.g. immunocytochemistry) or fundamental immunology (e.g. antibody and lymphocyte assays), are considered for publication.