Abstract Details

Title Clinical characterisation of patients in the post-acute stage of anti-NMDA receptor encephalitis: a prospective cohort study and comparison with patients with schizophrenia spectrum disorders

Topic Autoimmune Neurology

Presentation(s) S22 - Autoimmune Neurology: Autoimmune Encephalitis and Other Antibody-associated Syndromes (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Background NMDARe is associated with protracted symptoms during a post-acute stage that is not well known.

Objective To characterize the clinical features of the post-acute stage of anti-NMDAR encephalitis (NMDARe), the similarities with schizophrenia spectrum disorders (SCZ), and the factors that predict cognitive-psychiatric outcomes.

Design/Methods In this prospective observational study, patients in the post-acute stage of NMDARe underwent 3 visits (V1, study entry; V2, 6 months; V3, 12 months) including comprehensive neuropsychiatric evaluations at Hospital Clínic, Barcelona. SCZ patients and healthy participants (HC) undertook similar evaluations. Linear mixed-effect models served to assess longitudinal differences in measures.

Results 28 NMDARe, 27 SCZ, and 27 HC were recruited. Although, by V1 (median 4 months [IQR 3–7] from disease onset), many acute-stage NMDARe symptoms had resolved (acute stage median mRS 5 [IQR 4–5] vs V1 mRS [1–2]; p<0.0001), 89% of patients showed deficits in ≥1 cognitive domain (CD). In NMDARe, 15/22 (68%) CD variables were impaired at V1, whereas only 8/22 (36%) were altered at V3 (p=0.016). In SCZ, 11/22 (50%) variables (all shared with NMDARe) were impaired at V1, without changes at V3. Two acute-stage NMDARe features (decreased consciousness; no improvement within first 4 weeks of treatment) predicted CD outcomes, and a visuospatial task (serial biases) at V1 showed potential in predicting learning and memory outcomes. At V1, all psychiatric symptom clusters were similarly altered in NMDARe and SCZ, but only NMDARe subsequently improved (p=0.031). The greatest NMDARe cognitive-psychiatric improvement occurred between V1-V2. During this interval, 14% NMDARe patients would have met the diagnostic criteria of schizophrenia if CSF antibody findings had not been investigated.

Conclusions

The cognitive-psychiatric symptoms of post-acute NMDARe resembled those of stabilized schizophrenia, but only NMDARe patients progressively improved, predominantly during V1-V2. These findings are important for clinical trials on NMDARe and suggest that prompt cognitive-psychosocial rehabilitation may be valuable.

Authors/Disclosures
Mar Guasp, MD (Hospital Clínic Barcelona - IDIBAPS) PRESENTER	Dr. Guasp has nothing to disclose.
	No disclosure on file
Amaia Muñoz-Lopetegi (Hospital Clinic of Barcelona)	Ms. Muñoz-Lopetegi has nothing to disclose.
Eugenia Martinez-Hernandez, MD (Hospital Clinic Barcelona)	The institution of Dr. Martinez-Hernandez has received research support from Instituto de Salud Carlos III. Dr. Martinez-Hernandez has received personal compensation in the range of $0-$499 for serving as a travel and speaking honoraria with Biogen. Dr. Martinez-Hernandez has received personal compensation in the range of $0-$499 for serving as a travel honoraria with UCB.
Thais Armangue, MD (IDIBAPS-HClinic)	Dr. Armangue has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. The institution of Dr. Armangue has received research support from ISCIII(Spanish institute of health) -PI21/00316, Marato TV3, La Caixa Research Foundadion, Pablove Foundation (689368), Torrons Vicens Foundation (PFNR0144), 2021 Invest AEP.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Helena Arino, MD, PhD (Fundacio Clinic)	Ms. Arino has nothing to disclose.
	No disclosure on file
	No disclosure on file
Domingo Escudero, MD (Hospital Germans Trias I Pujol)	Dr. Escudero has nothing to disclose.
Sara Llufriu	Sara Llufriu has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Sara Llufriu has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Sara Llufriu has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merci. Sara Llufriu has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbot. Sara Llufriu has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi.
Raquel Sanchez Del Valle Diaz, MD	No disclosure on file
Joan Santamaria, MD (Hospital Clinic of Barcelona)	Joan Santamaria, MD has nothing to disclose.
	No disclosure on file
	No disclosure on file
Josep O. Dalmau, MD, PhD, FAAN	Dr. Dalmau has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astellas Research Institute of America. Dr. Dalmau has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen Research & Development . Dr. Dalmau has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. An immediate family member of Dr. Dalmau has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Dalmau has received research support from Sage Therapeutics. The institution of Dr. Dalmau has received research support from Edmond J.Safra Foundation . The institution of Dr. Dalmau has received research support from La Caixa Foundation. The institution of Dr. Dalmau has received research support from Spanish Ministry of Health (ISCIII). The institution of Dr. Dalmau has received research support from Euroimmun, Inc. Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. Dr. Dalmau has received publishing royalties from a publication relating to health care. Dr. Dalmau has received publishing royalties from a publication relating to health care. Dr. Dalmau has received publishing royalties from a publication relating to health care.