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1.
Front Immunol ; 12: 752557, 2021.
Article in English | MEDLINE | ID: covidwho-1789371

ABSTRACT

Objective: To analyze and compare different clinical, laboratory, and magnetic resonance imaging characteristics between pediatric and adult patients with first-attack myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and to explore predictive factors for severity at disease onset. Methods: Patients diagnosed with MOGAD at the First Affiliated Hospital of Zhengzhou University from January 2013 to August 2021 were enrolled in this retrospective study. Age at disease onset, sex, comorbidities, laboratory tests, magnetic resonance imaging (MRI) characteristics, and Expanded Disability Status Scale (EDSS) scores were collected and analyzed. The association between risk factors and initial EDSS scores at disease onset was analyzed using logistic regression models and Spearman correlation analyses. A receiver-operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of the uric acid and homocysteine (Hcy) levels for the severity of neurological dysfunction at the onset of MOGAD. Results: Sixty-seven patients (female, n=34; male, n=33) with first-attack MOGAD were included in this study. The mean age at onset was 26.43 ± 18.22 years (range: 3-79 years). Among patients <18 years of age, the most common presenting symptoms were loss of vision (36.0%), and nausea and vomiting (24.0%), and the most common disease spectrum was acute disseminated encephalomyelitis (ADEM) (40.0%). Among patients aged ≥18 years, the most common presenting symptoms were loss of vision (35.7%), paresthesia (33.3%), and paralysis (26.2%), and the most common disease spectrum was optic neuritis (35.7%). The most common lesions were cortical gray matter/paracortical white matter lesions in both pediatric and adult patients. Uric acid [odds ratio (OR)=1.014; 95% confidence interval (CI)=1.006-1.022; P=0.000] and serum Hcy (OR=1.125; 95% CI=1.017-1.246; P=0.023) levels were significantly associated with the severity of neurological dysfunction at disease onset. Uric acid levels (r=0.2583; P=0.035) and Hcy levels (r=0.3971; P=0.0009) were positively correlated with initial EDSS scores. The areas under the ROC curve were 0.7775 (95% CI= 0.6617‒0.8933; P<0.001) and 0.6767 (95% CI=0.5433‒0.8102, P=0.014) for uric acid and Hcy levels, respectively. Conclusion: The clinical phenotype of MOGAD varies in patients of different ages. The most common disease spectrum was ADEM in patients aged<18 years, while optic neuritis was commonly found in patients aged ≥18 years. The uric acid and Hcy levels are risk factors for the severity of neurological dysfunction at disease onset in patients with first-attack MOGAD.


Subject(s)
Autoantibodies/immunology , Autoimmune Diseases of the Nervous System/epidemiology , Myelin-Oligodendrocyte Glycoprotein/immunology , Adolescent , Adult , Age of Onset , Aged , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Autoimmune Diseases of the Nervous System/diagnostic imaging , Autoimmune Diseases of the Nervous System/immunology , Autoimmune Diseases of the Nervous System/metabolism , Biomarkers , Central Nervous System/diagnostic imaging , Cerebrospinal Fluid Proteins/analysis , Child , Child, Preschool , China/epidemiology , Comorbidity , Diagnosis, Differential , Female , Follow-Up Studies , Homocysteine/blood , Humans , Immunosuppressive Agents/therapeutic use , Magnetic Resonance Imaging , Male , Middle Aged , Risk Factors , Severity of Illness Index , Single-Blind Method , Uric Acid/blood , Young Adult
2.
Front Immunol ; 13: 825103, 2022.
Article in English | MEDLINE | ID: covidwho-1785336

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has had an enormous impact on the world, affecting people's lifestyle, economy, and livelihood. Recently, with the development of vaccines, the number of infected cases has decreased. Many case reports have revealed that COVID-19 may induce other serious comorbidities such as anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis. Anti-NMDA receptor encephalitis is an acute autoimmune disease that occurs more commonly in women than in men. To explore the association between COVID-19 and anti-NMDA receptor encephalitis, the microRNA (miRNA) biomarkers of COVID-19, anti-NMDA receptor encephalitis, and other related diseases from the literature are reviewed; then on the basis of these miRNA biomarkers, the relationship between COVID-19 and anti-NMDA receptor encephalitis is discussed. miRNAs are small non-coding RNAs that play important roles in cell differentiation, development, cell-cycle regulation, and apoptosis. miRNAs have been used as biological biomarkers for many diseases. The results in this study reveal that the relationship between anti-NMDA receptor encephalitis and COVID-19 infection or COVID-19 vaccination cannot be excluded; however, the risk that COVID-19 triggers the anti-NMDA receptor encephalitis is not high.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , COVID-19 , MicroRNAs , Biomarkers , COVID-19 Vaccines , Female , Humans , Male , MicroRNAs/genetics
3.
Mult Scler Relat Disord ; 62: 103795, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1773655

ABSTRACT

INTRODUCTION: There are increasing reports of COVID-19 related neurological complications which may be due to direct viral invasion, or immune mediated inflammatory diseases such as autoimmune encephalitis and ADEM (acute demyelinating encephalomyelitis). In this study, a systematic review is presented of the reported cases infected by the COVID-19 who were diagnosed with various forms of autoimmune encephalitis (AE). METHODS: The authors searched three databases including PubMed, Scopus, and Web of science for extracting original articles on coronavirus/ COVID-19 and AE. RESULTS: Eighteen articles were considered in this study, including 15 case reports, and three case series with a total of 81 patients. Among the studies, 19 cases were reported with AE including 7 (37%) cases of limbic encephalitis, 5 (26%) patients with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis, 2 (11%) with AE presenting as new-onset refractory status epilepticus (NORSE), 1 (5%) case of steroid-responsive encephalitis, and 4 (21%) cases with an unknown type of AE. CONCLUSION: Our systematic review revealed evidence on AE development in patients infected with the COVID-19. Clinicians should be aware of the possible diagnosis of AE when considering other neurological differential diagnosis in SARS-CoV-2 infected patients.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , COVID-19 , Hashimoto Disease , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , COVID-19/complications , Encephalitis , Hashimoto Disease/complications , Hashimoto Disease/diagnosis , Humans , SARS-CoV-2
4.
Hum Vaccin Immunother ; 18(1): 2033540, 2022 12 31.
Article in English | MEDLINE | ID: covidwho-1722107

ABSTRACT

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a relatively unknown autoimmune entity. Scant reports of post-infection/vaccination anti-NMDAR encephalitis exist. We, hereby, reviewed the relevant cases and added to the literature a possible case of anti-NMDAR encephalitis following COVID-19 vaccination with BBIBP-CorV (Sinopharm). A 50-year-old Persian woman with previously known rituximab-treated MS presented complaining of worsening neurological symptoms all gradually starting and worsening after receiving the second dose of BBVIP-CorV 2 weeks before. Notable findings in her physical examination included ataxic gait and Babinski sign. Considering an acute MS relapse, corticosteroid pulse therapy was initiated, and she was referred for MRI, which revealed multiple new plaques. Her serum sample interestingly tested positive for anti-NMDAR antibodies. CSF analysis was unfortunately not performed. She responded well to the corticosteroid pulse therapy and showed substantial resolution of the symptoms. Considering its relatively low cost of workup and the benefits of correct early diagnosis, clinicians are advised to consider autoimmune encephalitis encountering patients with progressive neurological symptoms after the administration of vaccines, including the ones for COVID-19 which are currently being used extensively.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , COVID-19 , Multiple Sclerosis , Adrenal Cortex Hormones , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/drug therapy , COVID-19 Vaccines , Female , Humans , Middle Aged , Neoplasm Recurrence, Local , Receptors, N-Methyl-D-Aspartate , Rituximab/therapeutic use , Vaccination
5.
Childs Nerv Syst ; 37(12): 3919-3922, 2021 12.
Article in English | MEDLINE | ID: covidwho-1525534

ABSTRACT

Anti-N-methyl-D-aspartate receptor encephalitis is a clinical condition characterized by acute behavioral and mood changes, abnormal movements, autonomic instability, seizures, and encephalopathy. We describe a 7-year-old boy diagnosed with autoimmune encephalitis due to NMDAR antibody in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019) (COVID-19), without pulmonary involvement or fever. The patient presented with acute ataxia, rapidly developed encephalopathy, and autoimmune encephalitis was suspected. Steroid treatment was withheld because of lymphopenia and intravenous immunoglobulin was started. The absence of clinical response prompted plasmapheresis and, when lymphocyte counts improved, pulse steroid treatment was applied. The latter was followed by significant improvement and the patient was discharged in a conscious and ambulatory state. Autoimmune encephalitis should be considered in the presence of neurological symptoms accompanying SARS-CoV-2 infection and steroid treatment should be preferred unless limited by contraindications.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , COVID-19 , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/drug therapy , Child , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , SARS-CoV-2 , Seizures
6.
J Neuroinflammation ; 18(1): 245, 2021 Oct 28.
Article in English | MEDLINE | ID: covidwho-1496192

ABSTRACT

Approximately 30% of individuals with severe SARS-CoV-2 infections also develop neurological and psychiatric complaints. In rare cases, the occurrence of autoimmune encephalitis has been reported after SARS-CoV-2 infection. In this systematic review, we have identified eight SARS-CoV-2-associated cases of anti-NMDA receptor encephalitis. All had cerebrospinal fluid antibodies against the NMDA receptor and a recent onset of working memory deficits, altered mental status, or psychiatric symptoms, such as confusion, agitation, auditory hallucination, catatonia and speech dysfunction. All patients received high-dose steroid and immunoglobulin therapeutics and conditions improved in each case. These findings suggest that clinical attention should be paid to warning signs of autoimmune encephalitis in severe COVID-19 cases. If characteristic features of autoimmune encephalitis are present, autoantibody diagnostics should be performed and confirmed cases should be treated with immunotherapy to minimize neurological impairments.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis/virology , COVID-19/complications , Mental Disorders/virology , Receptors, N-Methyl-D-Aspartate/immunology , Adolescent , Adult , Autoantibodies/immunology , COVID-19/immunology , Child , Female , Humans , Infant , Male , Middle Aged , Molecular Mimicry , SARS-CoV-2/immunology , Young Adult
7.
Asian J Psychiatr ; 63: 102761, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1306832

ABSTRACT

Catatonia is a rare neuropsychiatric syndrome that can accompany various medical conditions, including schizophrenia, autoimmune encephalitis, and infectious diseases. We present two cases of catatonia in males aged 12 and 17 years from Central Asia who tested positive for SARS-Cov-2 antibodies. Detailed medical assessments declined other potential precipitating factors, including schizophrenia or anti-NMDA receptor autoimmune encephalitis. FDG-PET in the younger patient demonstrated focal hypometabolism in left frontotemporal and right associative visual cortex, matching patterns previously seen in adults with catatonia. These isolated findings raise concerns about a possible causal relationship between COVID-19 infection and risk of catatonia manifestation in adolescents.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , COVID-19 , Catatonia , Adolescent , Adult , Asia , Catatonia/etiology , Humans , Incidental Findings , Male , SARS-CoV-2
8.
J Neurovirol ; 27(3): 504-506, 2021 06.
Article in English | MEDLINE | ID: covidwho-1202860

ABSTRACT

COVID-19 encephalitis is a rare condition usually presenting with altered mental status. Simultaneous presence of anti-NMDAR antibody and SARS-CoV-2 virus in CSF is a very rare condition described in a few case reports so far. On the other hand, brain edema is an unusual presentation of anti-NMDAR encephalitis. Herein, we reported a case with simultaneous detection of anti-NMDAR antibody and SARS-CoV-2 virus in her cerebrospinal fluid (CSF) presenting with brain edema, altered mental status, seizures, and respiratory symptoms.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications , COVID-19/complications , Adolescent , Female , Humans , SARS-CoV-2
9.
Childs Nerv Syst ; 37(12): 3919-3922, 2021 12.
Article in English | MEDLINE | ID: covidwho-1182245

ABSTRACT

Anti-N-methyl-D-aspartate receptor encephalitis is a clinical condition characterized by acute behavioral and mood changes, abnormal movements, autonomic instability, seizures, and encephalopathy. We describe a 7-year-old boy diagnosed with autoimmune encephalitis due to NMDAR antibody in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019) (COVID-19), without pulmonary involvement or fever. The patient presented with acute ataxia, rapidly developed encephalopathy, and autoimmune encephalitis was suspected. Steroid treatment was withheld because of lymphopenia and intravenous immunoglobulin was started. The absence of clinical response prompted plasmapheresis and, when lymphocyte counts improved, pulse steroid treatment was applied. The latter was followed by significant improvement and the patient was discharged in a conscious and ambulatory state. Autoimmune encephalitis should be considered in the presence of neurological symptoms accompanying SARS-CoV-2 infection and steroid treatment should be preferred unless limited by contraindications.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , COVID-19 , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/drug therapy , Child , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , SARS-CoV-2 , Seizures
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