Lateonsetanti–NMDAreceptor.pdf

Late-onset anti–NMDA receptor encephalitis Maarten J. Titulaer, MD, ABSTRACT PhD Objective: To describe the clinical features and outcome of anti–NMDA receptor (NMDAR) Lindsey McCracken, encephalitis in patients $45 years old. MPH Method: Observational cohort study. Iñigo Gabilondo, MD Takahiro Iizuka, MD, Results: In a cohort of 661 patients with anti-NMDAR encephalitis, we identified 31 patients $45 PhD years old. Compared with younger adults (18–44 years), older patients were more often male Izumi Kawachi, MD, (45% vs 12%, p , 0.0001), had lower frequency of tumors (23% vs 51%, p 5 0.002; rarely PhD teratomas), had longer median time to diagnosis (8 vs 4 weeks, p 5 0.009) and treatment (7 vs L. Bataller, MD, PhD 4 weeks, p 5 0.039), and had less favorable outcome (modified Rankin Scale score 0–2 at 2 A. Torrents, BS years, 60% vs 80%, p , 0.026). In multivariable analysis, younger age (odds ratio [OR] 0.15, Myrna R. Rosenfeld, MD, confidence interval [CI] 0.05–0.39, p 5 0.0001), early treatment (OR 0.60, CI 0.47–0.78, p , PhD 0.0001), no need for intensive care (OR 0.09, CI 0.04–0.22, p , 0.0001), and longer follow-up Rita Balice-Gordon, PhD (p , 0.0001) were associated with good outcome. Rituximab and cyclophosphamide were effec- Francesc Graus, MD, tive when first-line immunotherapies failed (OR 2.93, CI 1.10–7.76, p 5 0.031). Overall, 60% of PhD patients older than 45 years had full or substantial recovery at 24 months follow-up. Josep Dalmau, MD, PhD Conclusions: Anti-NMDAR encephalitis is less severe in patien