抗NMDA受体脑炎的临床和脑电图特点

Clinical features of anti-NMDA receptor encephalitis

目的：研究抗N-甲基-M-天冬氨酸（NMDA）受体脑炎患者的临床特点，以提高对这种自身免疫性疾病的认识。方法：对3例经血清（其中1例并作脑脊液）抗NMDA受体抗体检测诊为抗NMDA受体脑炎的患者，对病史、认知功能、脑脊液、头颅影像学、EEG、妇科B超、治疗方案等资料进行详细分析，并随访3～6个月。结果：3例患者均为女性，起病年龄13岁（2例）和25岁，以精神异常和癫痫发作为首发症状，病程中表现出意识障碍、运动障碍、语言障碍和认知障碍。脑脊液、头颅MRI和EEG表现为非特异改变，未发现伴发肿瘤。病程3～6个月。结论：抗NMDA受体脑炎临床表现易与病毒性脑炎混淆，对于不明原因的脑炎，尤其病程较长者，应尽早进行抗NMDA受体抗体检测。

Objective ： To make a better understanding of the features of anti-N-methyl-D-aspartate receptor （NMDAR） encephalitis in patients with this autoimmune disease. Methods：Diagnoses of 3 patients were confirmed by antibody detection in serum or CSF. All the clinical data,including disease history, CSF data, cranial MR images, EEG, mini-mental state examination （.MMSE）, pelvic ultrasound and treatment strategy were carefully analyzed. Three to six months follow-up were carried out. Results：3 female patients with onset at age of 13 years （2 case） and 25 years （1 case）showed common manifestation of psychiatric symptoms, seizures, which were the initial signs of this disease, and changes of consciousness, movement disorder, speech disturbance and cognitive impairment. Changes of CSF, cranial MR image and EEG nwere not speciffic. With antiviral and immunosuppression treatment, all the 3 patients became recovered to different contents 3 to 6 months later. Conclusion： Both female children and adults may suffer from anti-NMDA receptor encephalitis,which chould be confused with viral encephalitis. Movement disorder and seizures may occur in the same patient. Tumors can＇t always be detected in any case,especially in young children. Timely antibody detection is neccessary for anti-NMDA receptors.