PT  - JOURNAL ARTICLE
AU  - Titulaer, Maarten J.
AU  - McCracken, Lindsey
AU  - Gabilondo, Iñigo
AU  - Iizuka, Takahiro
AU  - Kawachi, Izumi
AU  - Bataller, L.
AU  - Torrents, A.
AU  - Rosenfeld, Myrna R.
AU  - Balice-Gordon, Rita
AU  - Graus, Francesc
AU  - Dalmau, Josep
TI  - Late-onset anti–NMDA receptor encephalitis
AID  - 10.1212/WNL.0b013e3182a4a49c
DP  - 2013 Sep 17
TA  - Neurology
PG  - 1058--1063
VI  - 81
IP  - 12
4099  - http://n.neurology.org/content/81/12/1058.short
4100  - http://n.neurology.org/content/81/12/1058.full
SO  - Neurology2013 Sep 17; 81
AB  - Objective: To describe the clinical features and outcome of anti–NMDA receptor (NMDAR) encephalitis in patients ≥45 years old.Method: Observational cohort study.Results: In a cohort of 661 patients with anti-NMDAR encephalitis, we identified 31 patients ≥45 years old. Compared with younger adults (18–44 years), older patients were more often male (45% vs 12%, p < 0.0001), had lower frequency of tumors (23% vs 51%, p = 0.002; rarely teratomas), had longer median time to diagnosis (8 vs 4 weeks, p = 0.009) and treatment (7 vs 4 weeks, p = 0.039), and had less favorable outcome (modified Rankin Scale score 0–2 at 2 years, 60% vs 80%, p < 0.026). In multivariable analysis, younger age (odds ratio [OR] 0.15, confidence interval [CI] 0.05–0.39, p = 0.0001), early treatment (OR 0.60, CI 0.47–0.78, p < 0.0001), no need for intensive care (OR 0.09, CI 0.04–0.22, p < 0.0001), and longer follow-up (p < 0.0001) were associated with good outcome. Rituximab and cyclophosphamide were effective when first-line immunotherapies failed (OR 2.93, CI 1.10–7.76, p = 0.031). Overall, 60% of patients older than 45 years had full or substantial recovery at 24 months follow-up.Conclusions: Anti-NMDAR encephalitis is less severe in patients ≥45 years old than in young adults, but the outcome is poorer in older patients. In this age group, delays in diagnosis and treatment are more frequent than in younger patients. The frequency of underlying tumors is low, but if present they are usually carcinomas instead of teratomas in younger patients. Early and aggressive immunotherapy will likely improve the clinical outcome.CI=confidence interval; IQR=interquartile range; mRS=modified Rankin Scale; NMDAR=NMDA receptor; OR=odds ratio