Risk factors for epilepsy recurrence in anti-N-methyl-D-aspartate receptor encephalitis patients with epileptic seizure

doi:10.3969/j.issn.1672-6731.2025.11.009

Abstract

Abstract: Objective To investigate the risk factors for epilepsy recurrence in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients with epileptic seizure. Methods A total of 78 anti-NMDAR encephalitis patients with epileptic seizure admitted to Beijing Tiantan Hospital, Capital Medical University from August 2013 to September 2022 were included. Clinical data of the patients were analyzed, and epilepsy recurrence was observed during follow-up period. According to whether epilepsy recurrence occurred during the follow-up period, the patients were divided into epilepsy recurrence group (n=18) and epilepsy non-recurrence group (n=60). Univariate and multivariate Logistic regression analyses were used to screen risk factors for epilepsy recurrence in anti-NMDAR encephalitis patients with epileptic seizure. Results During (2.21 ± 0.45) years' follow-up, 18 cases (23.08%) experienced epilepsy recurrence. Multivariate Logistic regression analysis showed that combined tumors (OR=24.154, 95%CI: 2.597-224.640; P=0.005), cognitive impairment (OR=7.809, 95%CI: 1.338-45.557; P=0.022), and cortical lesions on MRI (OR=9.868, 95%CI: 1.223-79.620; P=0.032) were risk factors for epilepsy recurrence in anti-NMDAR encephalitis patients with epileptic seizure. Conclusions Combined tumors, cognitive impairment, and cortical lesions on MRI are risk factors for epilepsy recurrence in anti-NMDAR encephalitis patients with epileptic seizure. For patients with these factors, longer duration of antiepileptic seizure medicine (ASM) should be used to avoid epilepsy recurrence.

Key words: Anti-N-methyl-D-aspartate receptor encephalitis, Epilepsy, Recurrence, Prognosis, Risk factors, Logistic models

摘要： 目的筛查伴癫痫发作的抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者癫痫复发的危险因素。方法纳入2013年8月至2022年9月首都医科大学附属北京天坛医院收治的78例伴癫痫发作的抗NMDAR脑炎患者，根据随访期间是否癫痫复发分为癫痫复发组（18例）和癫痫未复发组（60例），单因素和多因素Logistic回归分析筛查伴癫痫发作的抗NMDAR脑炎患者癫痫复发的危险因素。结果共78例患者中18例（23.08%）随访期间［平均（2.21 ± 0.45）年］癫痫复发。多因素Logistic回归分析显示，合并肿瘤（OR=24.154，95% CI：2.597~224.640；P=0.005）、认知功能障碍（OR=7.809，95% CI：1.338~45.557；P=0.022）和头部MRI表现为皮质病变（OR=9.868，95% CI：1.223~79.620；P=0.032）是伴癫痫发作的抗NMDAR脑炎患者癫痫复发的危险因素。结论对于合并肿瘤、认知功能障碍和头部MRI表现为皮质病变的伴癫痫发作的抗NMDAR脑炎患者，应更长期应用抗癫痫发作药物，以避免癫痫复发。

关键词: 抗N-甲基-D-门冬氨酸受体脑炎, 癫痫, 复发, 预后, 危险因素, Logistic模型

WANG Xue, LIU Xiao, WANG Qun. Risk factors for epilepsy recurrence in anti-N-methyl-D-aspartate receptor encephalitis patients with epileptic seizure[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(11): 1034-1039.

王雪, 刘霄, 王群. 伴癫痫发作的抗N-甲基-D-天冬氨酸受体脑炎患者癫痫复发危险因素分析[J]. 中国现代神经疾病杂志, 2025, 25(11): 1034-1039.

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