NEUROPSYCHIATRIC HALLMARKS OF ANMDARE

Objective: To determine the neuropsychiatric hallmarks of ANMDARE, as compared to patients with a negative determination of NMDAR-antibodies. Methods: A prospective, longitudinal, and comparative study was conducted, with patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis, or showed red flags. Patients were included in a six-year period, by means of a consecutive case sampling. Clinical assessments were done before knowing NMDAR antibodies results, including a bespoke inventory to register a large scope of neuropsychiatric features, the Bush and Francis Catatonia Rating Scale, and the Confusion Assessment Method. Patients were classified according to DSM-5. CSF antibodies against the NR1 subunit of N-methyl-D-aspartate receptor were processed at Labco Nous Diagnostics, Barcelona. Results: After obtaining the CSF antibodies results in 120 consecutive cases, 80 patients were positive and classified as having a definitive ANMDARE. 40 remaining patients were negative. The most distinctive features of ANMDARE were excited catatonia, delirium with catatonic signs, manic syndrome, psychomotor agitation, aggressive behavior, seizures, movement disorders (mainly orolingual dyskinesia), and hypoventilation.**研究目标**：对比N-甲基-D-天冬氨酸受体（N-methyl-D-aspartate receptor，简称NMDAR）抗体检测阴性的患者，明确抗N-甲基-D-天冬氨酸受体脑炎（ANMDARE）的神经精神标志性特征。 **研究方法**：本研究为前瞻性、纵向对照研究，纳入墨西哥国立神经病学与神经外科学研究所收治的符合可疑自身免疫性脑炎诊断标准或存在预警征象的患者。研究纳入周期为6年，采用连续病例抽样法选取研究对象。所有临床评估均在获知NMDAR抗体检测结果前完成，评估工具包括用于记录多维度神经精神特征的定制化量表、布什-弗朗西斯紧张症评定量表（Bush and Francis Catatonia Rating Scale）以及意识模糊评估法（Confusion Assessment Method）。所有患者均依据《精神障碍诊断与统计手册第五版》（DSM-5）进行分类。针对NMDAR的NR1亚基的脑脊液抗体检测由巴塞罗那Labco Nous Diagnostics实验室完成。 **研究结果**：本研究共纳入120例连续病例并完成脑脊液抗体检测，其中80例抗体检测结果为阳性，被确诊为ANMDARE；剩余40例抗体检测结果为阴性。ANMDARE最具特征性的神经精神表现包括兴奋性紧张症、伴紧张症体征的谵妄、躁狂综合征、精神运动性激越、攻击行为、癫痫发作、运动障碍（以口舌异动症（orolingual dyskinesia）为主）以及通气不足。