https://doi.org/10.55788/7d0e8f69
Anti-NMDA Receptor (anti-NMDAR) encephalitis is the most common autoimmune encephalitis characterised by complex neuropsychiatric features and the presence of immunoglobulin G antibodies against the NR1 subunit of the NMDA receptors in the central nervous system, and early diagnosis and treatment can be beneficial for the final outcome [1]. “With the NEOS score, we can adequately predict the outcome of patients with anti-NMDAR encephalitis 1 month after treatment,” said Dr Juliette Brenner (Erasmus University Medical Centre, the Netherlands). It would be better if physicians could predict the outcome of first-line therapy for these patients at the time of diagnosis. “Then we would know which patients would benefit from first-line therapy and which patients need to receive more aggressive therapies,” explained Dr Brenner. The research team developed the NEOS2 score to overcome these issues [2].
The NEOS2 tool was developed in a cohort of 712 patients with anti-NMDAR encephalitis from 5 countries. The original NEOS model included a ‘need for ICU admission’, MRI abnormalities, CSF leukocyte count >20 cells/µL, a treatment delay >4 weeks, and a lack of response to first-line therapy as independent variables. By adding age and the interaction effect between treatment delay and the number of leukocytes to the model and omitting the effect of first-line therapy, the NEOS2 score yielded the same accuracy for predicting the 1-year outcome as the original NEOS score. Furthermore, the new model successfully predicted response to first-line therapy and which patients would return to school or work after 3 years. Because of the omission of first-line therapy effect as a variable, the NEOS2 score can already be used at diagnosis.
- Dalmau J, et al. Lancet Neurol. 2008 Dec;7(12):1091-8.
- Brenner J, et al. Predicting outcome and improvement after first-line treatment of anti-NMDAR encephalitis at diagnosis: the NEOS2 scores. Late-breaking session 2, 10th EAN Congress, 29 June–2 July 2024, Helsinki, Finland.
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