Objective: To describe the spectrum of abnormal movements and predictor of outcome in Thai patients with anti-NMDA receptor (NMDAR) encephalitis.

Background: Anti-NMDAR encephalitis mostly presented initially with neuropsychiatric symptoms or seizure followed by movement disorder. The abnormal movement outcome after treatment has not been studied systematically in Thai patients. Therefore, we clarify the patterns of abnormal movements and predictors of outcome in these patients.

Methods: Retrospective medical record reviewed of patients whose diagnosis with NMDAR encephalitis in Prasat Neurological Institute since June 2010 to December 2015.

Results: Total 30 patients were identified. Sixteen patients (53%) were female. Median age of onset was 21 years old (range 13-54). All patients were confirmed diagnosed by positivity of NMDAR transfected cell-based assay in CSF. The most common initial presentation was cognitive behavioral change (53.3%) followed by seizure (23.3%). None presented with abnormal movement as first and five patients did not develop it along clinical course. Movement disorder emerged in the third sequence from first clinical event (median time 18 days; 6-41). Fifty-six abnormal movements are classified in 5 patterns: (1) orobuccolingual dyskinesia; 39.2%, (2) limb myorhythmia; 19.6%, (3) limb dystonia; 19.6%, (4) truncal dystonia; 10.7%, (5) Other hypokinetic movements; 10.7%. EEG during abnormal movement existence were all reported as generalized slow wave. The median time from acute treatment to recovery in abnormal movement was 18 days (range 3-112), which was not difference in sex (p=0.870).
No positive correlation was found between time to treatment (categorize as less than or more than 4 weeks) and time to recovery in abnormal movement. Number of abnormal movement patterns in each patient affected the median time of recovery in behavioral symptoms (p=0.042) but not duration of abnormal movements (p=0.105). Four patients (13.3%) were relapse in median time 14 months after the first acute treatment.

Conclusions: The spectrum of abnormal movements was in third sequence followed neuropsychiatric symptoms and seizure. The most common form was orobuccolingual dyskinesia. Abnormal movements improved before cognitive deficit. Duration of recovery was not associated with sex and time to treatment except for number of abnormal movement patterns.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/the-spectrum-of-abnormal-movements-and-predictors-of-outcome-in-anti-nmda-receptor-encephalitis-in-thai-patients/