Comparison of clinical characteristics of anti-N-methyl-D-aspartate receptor encephalitis with positive and negative anti-thyroid antibodies

Abstract

Objective To summarize and compare the clinical characteristics of anti N-methyl-D-aspartate (NMDA) receptor encephalitis with positive and negative anti-thyroid antibodies (ATAbs), and explore the clinical characteristics and possible mechanism of anti-NMDA receptor encephalitis with positive ATAbs. Methods The clinical data of 53 patients with definitely diagnosed anti-NMDA receptor encephalitis, admitted to our hospital from January 2016 to April 2019, were collected. The patients were divided into two groups according to positive and negative ATAbs, and the clinical characteristics, experimental results and prognoses of the two groups were compared. Results Among the 53 patients, 16 were combined with positive ATAbs, of which 11 were female (68.8%); 37 were combined with negative ATAbs, of which 11 were female (29.7%); number of female patients in the positive ATAbs group was significantly larger than that in the negative ATAbs group (P 0.05). There were no significant differences in prodromal manifestations, first symptoms (abnormal mental behavior or cognitive impairment, and epilepsy), main clinical manifestations, and incidence of complications between the two groups (P>0.05). As compared with the negative ATAbs group, positive ATAbs group had significantly higher maximum modified Rankin scale scores (4[4, 5] vs. 3[2, 5]), abnormal rate of rheumatic immunity antibodies (50.0% vs. 13.6%), and rate of adopting two or more immunotherapy measures (93.7% vs. 51.4%; P<0.05). Conclusion The clinical manifestations of anti-NMDA receptor encephalitis in the positive ATAbs patients are similar to those in the negative ATAbs patients, but the illness is more serious; moreover, the positive ATAbs patients are mostly combined with multiple antibody abnormalities, which may require more active immunotherapy. Key words: Encephalitis; Anti-thyroid antibody; Hashimoto's encephalopathy; Autoantibody