title: Variations of movement disorders in anti-N-methyl-D-aspartate receptor encephalitis: A nationwide study in Taiwan.
abstract: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the most common autoimmune encephalitis that presents with a wide variety of movement disorders. The purpose of our study is to review the manifestations and duration of movement disorders in different ages with NMDAR encephalitis.A retrospective cohort of 28 patients (20 females and 8 males) with positive cerebrospinal fluid (CSF) anti-NMDAR antibody in a 5-year period from major hospitals in Taiwan was enrolled. They were categorized into 3 age groups: 7 patients were ≤10 years, 14 patients were 10 to 18 years, and 7 patients were >18 years.Total 28 patients (20 females and 8 males) with age ranging from 8 months to 38 years were enrolled. Nearly all patients (n = 27/28, 96%) presented with at least 2 types of disorders, including orofacial-lingual dyskinesia (OFLD; n = 20), catatonia (n = 19), tremor (n = 11), bradykinesia (n = 11), dystonia (n = 11), choreoathethosis (n = 9), and ballism (n = 3). Only 1 patient below 10 years presented with isolated periodic choreoathethosis without other movement disorders. OFLD was common in all age groups. Choreoathetosis was most common in patients aged ≤10 years, while catatonia was most common in patients aged >10 years (P = 0.001 and 0.020, respectively). Bradykinesia was also more common in patients aged >10 years (P = 0.020). The clinical presentations of movement disorders were not significantly different in the age of 10 to 18 years and those >18 years. Neither patient ≤10 years old nor male patients had associated tumors. All patients' movement disorders were improved after treatment, while female patients with tumors had worse short-term outcome (P = 0.014). Compared with other disorders, choreoathetosis persisted significantly longer in patients ≤10 years (P = 0.038), while OFLD and catatonia last longer in patients >10 years (P = 0.047 and 0.002, respectively).Our study shows that hyperkinetic movements such as choreoathetosis are more common and last longer in younger age groups, whereas hypokinetic movements such as catatonia and bradykinesia are more common and last longer in older age groups. Female patients with ovarian tumors had worse short-term outcome.
authors.affiliation: Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Department of Pediatrics, Mackay Memorial Hospital, Taipei Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Bi-Chun
authors.initials: BC
authors.lastname: Duan
authors.forename: Wen-Chin
authors.initials: WC
authors.lastname: Weng
authors.forename: Kuang-Lin
authors.initials: KL
authors.lastname: Lin
authors.forename: Lee Chin
authors.initials: LC
authors.lastname: Wong
authors.forename: Sung-Tse
authors.initials: ST
authors.lastname: Li
authors.forename: Mei-Hsin
authors.initials: MH
authors.lastname: Hsu
authors.forename: Jainn-Jim
authors.initials: JJ
authors.lastname: Lin
authors.forename: Pi-Chaun
authors.initials: PC
authors.lastname: Fan
authors.forename: Ming-I
authors.initials: MI
authors.lastname: Lin
authors.forename: Nan-Chang
authors.initials: NC
authors.lastname: Chiu
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Lin
authors.forename: Huei-Shyong
authors.initials: HS
authors.lastname: Wang
authors.forename: Kun-Long
authors.initials: KL
authors.lastname: Hung
authors.forename: Wang-Tso
authors.initials: WT
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult