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Anti– N -Methyl- d -Aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care

Etienne de Montmollin 1 Sophie Demeret 2 Noëlle Brule 3 Marie Conrad 4 Frédéric Dailler 5 Nicolas Lerolle 6 Jean-Christophe Navellou 7 Carole Schwebel 8 Mikael Alves 9 Martin Cour 10 Nicolas Engrand 11 Jean-Marie Tonnelier 12 Eric Maury 13 Stephane Ruckly 14 Géraldine Picard 15 Véronique Rogemond 15 Éric Magalhaes 16 Tarek Sharshar 17 Jean-François Timsit 14, 16 Jérome Honnorat 15, 18 Romain Sonneville 16, 19 Encephalitica Study Group Benjamin Louart 20, 21
Abstract : RATIONALE: Encephalitis caused by anti-N-methyl-d-aspartate receptor (NMDAR) antibodies is the leading cause of immune-mediated encephalitis. There are limited data on intensive care unit (ICU) management of these patients. OBJECTIVES: To identify prognostic factors of good neurologic outcome in patients admitted to an ICU with anti-NMDAR encephalitis. METHODS: This was an observational multicenter study of all consecutive adult patients diagnosed with anti-NMDAR encephalitis at the French National Reference Centre, admitted to an ICU between 2008 and 2014. The primary outcome was a good neurologic outcome at 6 months after ICU admission, defined by a modified Rankin Scale score of 0-2. MEASUREMENTS AND MAIN RESULTS: Seventy-seven patients were included from 52 ICUs. First-line immunotherapy consisted of steroids (n = 61/74; 82%), intravenous immunoglobulins (n = 71/74; 96%), and plasmapheresis (n = 17/74; 23%). Forty-five (61%) patients received second-line immunotherapy (cyclophosphamide, rituximab, or both). At 6 months, 57% of patients had a good neurologic outcome. Independent factors of good neurologic outcome were early (≤8 d after ICU admission) immunotherapy (odds ratio, 16.16; 95% confidence interval, 3.32-78.64; for combined first-line immunotherapy with steroids and intravenous immunoglobulins vs. late immunotherapy), and a low white blood cell count on the first cerebrospinal examination (odds ratio, 9.83 for <5 vs. >50 cells/mm3; 95% confidence interval, 1.07-90.65). Presence of nonneurologic organ failures at ICU admission and occurrence of status epilepticus during ICU stay were not associated with neurologic outcome. CONCLUSIONS: The prognosis of adult patients with anti-NMDAR encephalitis requiring intensive care is good, especially when immunotherapy is initiated early, advocating for prompt diagnosis and early aggressive treatment.
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Soumis le : mercredi 5 décembre 2018 - 10:11:07
Dernière modification le : vendredi 11 décembre 2020 - 03:18:36



Etienne de Montmollin, Sophie Demeret, Noëlle Brule, Marie Conrad, Frédéric Dailler, et al.. Anti– N -Methyl- d -Aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care. American Journal of Respiratory and Critical Care Medicine, American Thoracic Society, 2017, 195 (4), pp.491-499. ⟨10.1164/rccm.201603-0507OC⟩. ⟨hal-01945068⟩



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