Volume 11, Issue 2 (2025)
IEM 2025, 11(2): 189-203 |
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Jachman-Kapułka J, Rorat M. Anti-NMDA Receptor Encephalitis Associated with SARS-CoV-2 Infection in the COVID-19 Pandemic: A Systematic Review. IEM 2025; 11 (2) :189-203
URL: http://iem.modares.ac.ir/article-4-75413-en.html
URL: http://iem.modares.ac.ir/article-4-75413-en.html
1- Department of Internal Medicine and Rheumathology, J. Gromkowski Specialist Regional Hospital, Wroclaw, Poland , justyna.jachman@gmail.com
2- Department of Social Sciences and Infectious Diseases, Medical Faculty, Wroclaw University of Science and Technology, Poland
2- Department of Social Sciences and Infectious Diseases, Medical Faculty, Wroclaw University of Science and Technology, Poland
Abstract: (165 Views)
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with neurological complications, like various autoimmune encephalitis (AE) types. This study aimed to identify and analyze COVID-19 cases diagnosed with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis (anti-NMDARE).
Materials & Methods: This research summarized all post-pandemic reports. The review was conducted based on PRISMA (preferred reporting items for systematic reviews and meta-analyses) 2020 guidelines. Electronic databases were search using search terms to find anti-NMDARE cases associated with COVID-19.
Findings: After analyzing 649 records, 16 patients (ten women and six men) with a median age of 19.5 years were identified. All AE cases were confirmed by the presence of anti-NMDAR IgG, dominant behaviour and mental status changes, psychiatric symptoms, epileptic seizures, movement disorders, and sleep and speech problems. Abnormalities were more common in electroencephalography (EEG) and cerebrospinal fluid (CSF) than in brain MRI scans. All patients received first-line guideline-based therapy (intravenous methylprednisolone, intravenous immunoglobulin, plasma exchange), and five patients received second-line immunotherapy (rituximab, azathioprine, cyclophosphamide). Nine out of 16 patients had complete recovery or significant improvement.
Conclusion: Considering the magnitude of the pandemic and the few anti-NMDAR encephalitis cases temporally diagnosed with COVID-19, this association was relatively rare. The appearance of characteristic features of encephalitis during SARS-CoV-2 infection necessitates further diagnostic tests, especially detection of auto-antibodies and possible neoplasm, since earlier diagnosis and treatment provide a better prognosis. This review highlights the need for further investigation into the co-occurrence of anti-NMDARE with COVID-19, long-term clinical outcomes, and possible relapses.
Materials & Methods: This research summarized all post-pandemic reports. The review was conducted based on PRISMA (preferred reporting items for systematic reviews and meta-analyses) 2020 guidelines. Electronic databases were search using search terms to find anti-NMDARE cases associated with COVID-19.
Findings: After analyzing 649 records, 16 patients (ten women and six men) with a median age of 19.5 years were identified. All AE cases were confirmed by the presence of anti-NMDAR IgG, dominant behaviour and mental status changes, psychiatric symptoms, epileptic seizures, movement disorders, and sleep and speech problems. Abnormalities were more common in electroencephalography (EEG) and cerebrospinal fluid (CSF) than in brain MRI scans. All patients received first-line guideline-based therapy (intravenous methylprednisolone, intravenous immunoglobulin, plasma exchange), and five patients received second-line immunotherapy (rituximab, azathioprine, cyclophosphamide). Nine out of 16 patients had complete recovery or significant improvement.
Conclusion: Considering the magnitude of the pandemic and the few anti-NMDAR encephalitis cases temporally diagnosed with COVID-19, this association was relatively rare. The appearance of characteristic features of encephalitis during SARS-CoV-2 infection necessitates further diagnostic tests, especially detection of auto-antibodies and possible neoplasm, since earlier diagnosis and treatment provide a better prognosis. This review highlights the need for further investigation into the co-occurrence of anti-NMDARE with COVID-19, long-term clinical outcomes, and possible relapses.
Article Type: Systematic Review |
Subject:
Virology
Received: 2024/06/1 | Accepted: 2024/08/21 | Published: 2025/06/22
Received: 2024/06/1 | Accepted: 2024/08/21 | Published: 2025/06/22
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