Association between maintenance regimens for immunotherapy and prognosis in patients with MRI-positive or MRI-negative anti-N-methyl-D-aspartate receptor encephalitis

Abstract

Objective To investigate the association between the maintenance regimens for immunotherapy and prognosis in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and different cranial MRI manifestations. Methods Diagnosis, treatment, and follow-up data were collected from 94 patients with a confirmed diagnosis of anti-NMDAR encephalitis in Qilu Hospital from January 2016 to January 2021, and the features of the disease were compared between the positive MRI group (group M with 35 patients) and the negative MRI group (group N with 59 patients), as well as the association between the maintenance regimens for immunotherapy and the long-term prognosis of patients. Results After follow-up for 4-73 months, group M had a median fCASE score of 1 (0,3), with 24 patients exhibiting poor symptomatic prognosis, and group N had a median fCASE score of 0 (0,1), with 21 patients exhibiting poor symptomatic prognosis, suggesting that group N had a better prognosis than group M (P<0.05). In group M, the patients who received long-term (treatment duration ≥6 months) immunotherapy had abetter symptomatic prognosis (P<0.05), while in group N, there was no significant difference in treatment outcome between the patients receiving short-term (treatment duration <6 months) immunotherapy and those receivinglong-term immunotherapy (P>0.05). Conclusion Autoimmune encephalitis patients with related responsible lesions found by cranial MRI have a relatively poor prognosis and should receive a longerterm of maintenance regimen for immunotherapy.

Keywords

• anti-n-methyl-d-aspartate receptor encephalitis|magnetic resonance imaging|immunotherapy|prognosis