Abstract Details

Title Ovarian resection in anti-NMDAr encephalitis: A comparison of aggressive and conservative approaches

Topic Autoimmune Neurology

Presentation(s) S41 - Autoimmune Neurology 3: Autoimmune Encephalitis, Paraneoplastic Neurologic Disorders, Antibody-Mediated Diseases, Immunology (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Background Resection of ovarian teratoma in patients with anti-N-methyl-D-aspartate receptor encephalitis (NMDArE) has been associated with significant neurological improvement. Evidence is currently lacking on the relative safety and effectiveness of different surgical management approaches.

Objective To compare one-year functional outcomes of patients with NMDArE who underwent aggressive versus conservative ovarian resection.

Design/Methods Patients with NMDArE who underwent ovarian resection between January 1^st 2012 and December 31^st 2020 were retrospectively identified from two tertiary centers. Primary outcome was good one-year functional status, defined as modified Rankin Scale (mRS) score of 0–2. Aggressive approach was defined as a one-step bilateral oophorectomy or ovarian resection without pre-operative imaging evidence of a teratoma. Fisher exact test and Wilcoxon tests were used to compare the two groups. We then performed a fixed-effect meta-analysis integrating the results from this study with other studies reporting functional outcomes based on surgical approach as defined above.

Results Fifteen patients were included in the study. Median age at encephalitis onset was 24 years (range: 19–73). Median delay from symptom onset to surgery was 36 days (range: 16–129). Seven patients (47%) underwent an aggressive surgical approach. Four out of seven (57%) patients in the aggressive approach group had a good outcome, compared with 6/8 (75%) in the conservative approach group (p=0.61). There were no statistically-significant differences in delay from symptom onset to treatment, length of ICU stay, or age between the two groups. One study was included in the meta-analysis (n=29, Dai et al. 2019), which revealed no statistical difference between the two surgical approaches (p=0.18).

Conclusions Aggressive (versus conservative) ovarian resection does not seem to improve neurological outcomes among patients with NMDArE. Clinicians should use caution when considering such surgical approaches.

Authors/Disclosures
Yajur Iyengar PRESENTER	Mr. Iyengar has nothing to disclose.
Julien Hebert, MD (Toronto Western Hospital (University Health Network))	Dr. Hebert has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Paladin Labs.
Seth A. Climans, MD (London Health Sciences Centre)	Dr. Climans has nothing to disclose.
Alexandra Muccilli, MD (Saint Michael's Hospital - Multiple Sclerosis Clinic)	Dr. Muccilli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Muccilli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Muccilli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Muccilli has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion.
Gregory S. Day, MD, MSc, FAAN (Mayo Clinic)	Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Parabon Nanolabs. The institution of Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Eli Lilly. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ionis. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for DynaMed (EBSCO Health). Dr. Day has stock in ANI Pharmaceuticals. The institution of Dr. Day has received research support from National Institutes of Health / NIA. The institution of Dr. Day has received research support from Chan Zuckerberg Initiative. The institution of Dr. Day has received research support from Alzheimer's Association. The institution of Dr. Day has received research support from National Institutes of Health / NINDS. The institution of Dr. Day has received research support from Horizon Therapeutics. The institution of Dr. Day has received research support from AVID Radiopharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Presenter at Annual Meeting (CME) with American Academy of Neurology. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development (CME) with PeerView, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Continuing Education, Inc. Dr. Day has a non-compensated relationship as a Clinical Director with AntiNMDA Receptor Encephalitis Foundation that is relevant to AAN interests or activities.
	No disclosure on file
David F. Tang-Wai, MD, FRCPC (Toronto Western Hospital/University Health Network)	Dr. Tang-Wai has nothing to disclose.