title: Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care.
abstract: 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.
  
  
  
  To identify prognostic factors of good neurologic outcome in patients admitted to an ICU with anti-NMDAR encephalitis.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 1 Polyvalent Intensive Care Unit, Centre Hospitalier de Saint-Denis, Saint-Denis, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: de Montmollin
authors.affiliation: 2 Neurologic Intensive Care Unit, Hôpital Pitié-Salpêtrière.
authors.forename: Sophie
authors.initials: S
authors.lastname: Demeret
authors.affiliation: 3 Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors.forename: Noëlle
authors.initials: N
authors.lastname: Brulé
authors.affiliation: 4 Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nancy, Nancy, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Conrad
authors.affiliation: 5 Neurologic Intensive Care Unit, Hôpital Pierre Wertheimer, Groupement Hospitalier Est, Hospices Civiles de Lyon, Lyon, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dailler
authors.affiliation: 6 Department of Medical Intensive Care and Hyperbaric Medicine, Centre Hospitalier Universitaire d'Angers, Angers, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lerolle
authors.affiliation: 7 Medical Intensive Care Unit, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Navellou
authors.affiliation: 8 Medical Intensive Care Unit, Hôpital Universitaire Albert Michallon, Grenoble, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.affiliation: 9 Polyvalent Intensive Care Unit, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France.
authors.forename: Mikaël
authors.initials: M
authors.lastname: Alves
authors.affiliation: 10 Medical Intensive Care Unit, Groupement Hospitalier Edouard Herriot, Hospices Civiles de Lyon, Lyon, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Cour
authors.affiliation: 11 Neurologic Intensive Care Unit, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Engrand
authors.affiliation: 12 Medical Intensive Care Unit, Hôpital de la Cavale Blanche, Centre Hospitalier Universitaire Régional de Brest, Brest, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tonnelier
authors.affiliation: 13 Medical Intensive Care Unit, Hôpital Saint-Antoine.
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
authors.affiliation: 14 Unité Mixte de Recherche (UMR) 1137, Infection Antimicrobials Modelling Evolution Team 5, DeSCID: Decision SCiences in Infectious Diseases, Control and Care, Institut National de la Santé et de la Recherche Médicale (INSERM), and.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ruckly
authors.affiliation: 15 French National Reference Centre for Paraneoplastic Neurologic Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; and.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Picard
authors.affiliation: 15 French National Reference Centre for Paraneoplastic Neurologic Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; and.
authors.forename: Véronique
authors.initials: V
authors.lastname: Rogemond
authors.affiliation: 16 Medical and Infectious Diseases Intensive Care Unit, Hôpital Bichat-Claude-Bernard, and.
authors.forename: Éric
authors.initials: É
authors.lastname: Magalhaes
authors.affiliation: 17 Polyvalent Intensive Care Unit, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
authors.affiliation: 16 Medical and Infectious Diseases Intensive Care Unit, Hôpital Bichat-Claude-Bernard, and.|14 Unité Mixte de Recherche (UMR) 1137, Infection Antimicrobials Modelling Evolution Team 5, DeSCID: Decision SCiences in Infectious Diseases, Control and Care, Institut National de la Santé et de la Recherche Médicale (INSERM), and.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.affiliation: 15 French National Reference Centre for Paraneoplastic Neurologic Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; and.|18 Institut NeuroMyoGene, INSERM U1217/Centre National de la Recherche Scientifique (CNRS), UMR 5310, Lyon, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Honnorat
authors.affiliation: 16 Medical and Infectious Diseases Intensive Care Unit, Hôpital Bichat-Claude-Bernard, and.|19 INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Sonneville
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000134:cerebrospinal fluid / Q000276:immunology* / Q000628:therapy; D001921:Brain / Q000503:physiopathology*; D005260:Female; D005602:France; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000627:therapeutic use*; D007167:Immunotherapy / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D059906:Neuroimaging / Q000379:methods; D010956:Plasmapheresis / Q000379:methods; D011379:Prognosis; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology; D012189:Retrospective Studies; D055502:Secondary Prevention; D017678:Sex Distribution; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007136:Immunoglobulins; D016194:Receptors, N-Methyl-D-Aspartate; D013256:Steroids
keywords: anti–N-methyl-d-aspartate receptor; critical care; encephalitis; immunotherapy; incidence