Home > Neurology > EAN 2024 > Neurological Risk Factors and Predictive Tools > Novel tool to predict outcomes in anti-NMDAR encephalitis

Novel tool to predict outcomes in anti-NMDAR encephalitis

Presented by
Dr Juliette Brenner, Erasmus University Medical Centre, the Netherlands
Conference
EAN 2024
Doi
https://doi.org/10.55788/7d0e8f69
An internationally validated, easy-to-use tool (NEOS2) can predict which patients with anti-NMDAR encephalitis will improve on first-line therapy at diagnosis.

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.

  1. Dalmau J, et al. Lancet Neurol. 2008 Dec;7(12):1091-8.
  2. 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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