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Joubert B, García-Serra A, Planagumà J, Martínez-Hernandez E, Kraft A, Palm F, Iizuka T, Honnorat J, Leypoldt F, Graus F, Dalmau J. Pregnancy outcomes in anti-NMDA receptor encephalitis: Case series. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/3/e668. [PMID: 31948997 PMCID: PMC7051205 DOI: 10.1212/nxi.0000000000000668] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/19/2019] [Indexed: 01/17/2023]
Abstract
Objective To report the effects of anti-NMDA receptor (NMDAR) encephalitis in pregnant patients and their babies. Methods We studied a retrospective cohort of patients who developed anti-NMDAR encephalitis during pregnancy or became pregnant while recovering from the encephalitis. In addition, we reviewed the English literature between 2010 and 2019 related to this topic. Results We studied 11 patients; 6 developed anti-NMDAR encephalitis during pregnancy, and 5 became pregnant while recovering. There were no obstetrical complications, but 6 (55%) babies were premature. Ten newborns were healthy, and 1 (9%) developed transient respiratory distress. Nine infants had assessable follow-up (median 18 months; range, 7–96 months), and all showed normal development. We identified 21 cases in the English literature. Obstetrical complications occurred in 7 (33%) pregnancies. Two patients died of septic shock (1 baby successfully delivered), another 2 had miscarriages, and in 2, the pregnancy was terminated. Sixteen babies (76%) were delivered, 9 (56%) premature. At birth, 13/16 (81%) newborns were healthy, 2/16 (13%) had transient neurologic or respiratory symptoms, and 1 (6%) died of brain edema. Follow-up (median 12 months; range, 6–36 months) was reported for 8 children: 7 (88%) showed normal development and behavior, and 1 (13%) cortical dysplasia. Immunotherapy was used during pregnancy in 7 (64%) of our patients and 18 (86%) of the reported cases, including rituximab in 4 cases, without adverse effects. Conclusions Patients who develop anti-NMDAR encephalitis during pregnancy or become pregnant during recovery often have obstetrical complications, but most of the newborns are healthy and appear to have normal development.
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Affiliation(s)
- Bastien Joubert
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA
| | - Anna García-Serra
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA
| | - Jesús Planagumà
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA
| | - Eugenia Martínez-Hernandez
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA
| | - Andrea Kraft
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA
| | - Frederick Palm
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA
| | - Takahiro Iizuka
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA
| | - Jérôme Honnorat
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA
| | - Frank Leypoldt
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA
| | - Francesc Graus
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA
| | - Josep Dalmau
- From the Neuroimmunology Program (B.J., A.G.-S., J.P., E.M.-H., F.G., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Spain; Department of Neurology (A.K.), Martha-Maria Hospital, Halle, Germany; Department of Neurology (F.P.), Helios Hospital, Schleswig, Germany; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; French Reference Center on Paraneoplastic Neurological Syndromes (B.J., J.H.), Hospices Civils de Lyon, SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1; France; Neuroimmunology Section (F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology (F.L.), Christian-Albrechts-University, Kiel, Germany; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, PA.
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