The spectrum of overlapping anti-NMDAR encephalitis and demyelinating syndromes: a systematic review of presentation, diagnosis, management, and outcomes
Background Anti-NMDAR encephalitis frequently overlaps with demyelinating diseases (MOGAD, NMOSD, MS), creating complex syndromes with diverse presentations and challenging management.Methods Systematic search of databases including MEDLINE, Google Scholar, Embase, Scopus, Cochrane Library, and Web...
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Taylor & Francis Group
2025-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2025.2517813 |
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| author | Saboor Saeed Huaizhi Wang Mengjie Jia Ting Ting Liu Le Xu Xuhong Zhang Shao-Hua Hu |
| author_facet | Saboor Saeed Huaizhi Wang Mengjie Jia Ting Ting Liu Le Xu Xuhong Zhang Shao-Hua Hu |
| author_sort | Saboor Saeed |
| collection | DOAJ |
| description | Background Anti-NMDAR encephalitis frequently overlaps with demyelinating diseases (MOGAD, NMOSD, MS), creating complex syndromes with diverse presentations and challenging management.Methods Systematic search of databases including MEDLINE, Google Scholar, Embase, Scopus, Cochrane Library, and Web of Science up to March 2024 for studies on co-existing anti-NMDAR encephalitis and demyelinating syndromes. Data extracted on clinical characteristics, diagnostics, treatments, and outcomes.Results Twenty-five studies identified 256 patients (16.2%) with co-existing Anti-NMDAR encephalitis and demyelinating syndromes, primarily MOGAD (94.5%), with fewer cases involving NMOSD or MS. The Anti-NMDAR + MOGAD subgroup exhibited seizures (51–72.7%), psychiatric symptoms (45.5–71.4%), cognitive dysfunction (30.6%), and movement disorders (30.6%). All patients had CSF anti-NMDAR antibodies, with MOG (60%) or AQP4 (25%) antibodies. Use of standardized, cell-based assays and adherence to established criteria are essential to avoid false positives, particularly for MOG. MRI abnormalities were seen in 75% of patients. First-line immunotherapies were effective in 70% of cases; 80% of refractory cases responded to second-line therapies.Conclusions Anti-NMDAR encephalitis overlapping with demyelinating diseases is challenging. Tailored treatments based on detailed immune profiles are key to better outcomes. |
| format | Article |
| id | doaj-art-85defa40148140e09ed501e98805f74e |
| institution | DOAJ |
| issn | 0785-3890 1365-2060 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
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| series | Annals of Medicine |
| spelling | doaj-art-85defa40148140e09ed501e98805f74e2025-08-20T02:43:13ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602025-12-0157110.1080/07853890.2025.2517813The spectrum of overlapping anti-NMDAR encephalitis and demyelinating syndromes: a systematic review of presentation, diagnosis, management, and outcomesSaboor Saeed0Huaizhi Wang1Mengjie Jia2Ting Ting Liu3Le Xu4Xuhong Zhang5Shao-Hua Hu6Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaNanhu Brain–Computer Interface Institute, Hangzhou, ChinaResearch Center of Clinical Pharmacy of The First Affiliated Hospital and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, ChinaDepartment of Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaDepartment of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaBackground Anti-NMDAR encephalitis frequently overlaps with demyelinating diseases (MOGAD, NMOSD, MS), creating complex syndromes with diverse presentations and challenging management.Methods Systematic search of databases including MEDLINE, Google Scholar, Embase, Scopus, Cochrane Library, and Web of Science up to March 2024 for studies on co-existing anti-NMDAR encephalitis and demyelinating syndromes. Data extracted on clinical characteristics, diagnostics, treatments, and outcomes.Results Twenty-five studies identified 256 patients (16.2%) with co-existing Anti-NMDAR encephalitis and demyelinating syndromes, primarily MOGAD (94.5%), with fewer cases involving NMOSD or MS. The Anti-NMDAR + MOGAD subgroup exhibited seizures (51–72.7%), psychiatric symptoms (45.5–71.4%), cognitive dysfunction (30.6%), and movement disorders (30.6%). All patients had CSF anti-NMDAR antibodies, with MOG (60%) or AQP4 (25%) antibodies. Use of standardized, cell-based assays and adherence to established criteria are essential to avoid false positives, particularly for MOG. MRI abnormalities were seen in 75% of patients. First-line immunotherapies were effective in 70% of cases; 80% of refractory cases responded to second-line therapies.Conclusions Anti-NMDAR encephalitis overlapping with demyelinating diseases is challenging. Tailored treatments based on detailed immune profiles are key to better outcomes.https://www.tandfonline.com/doi/10.1080/07853890.2025.2517813Anti-NMDAR encephalitismultiple sclerosismyelin oligodendrocyte glycoprotein antibody-associated diseaseneuromyelitis optica spectrum disorderoverlapping syndrome |
| spellingShingle | Saboor Saeed Huaizhi Wang Mengjie Jia Ting Ting Liu Le Xu Xuhong Zhang Shao-Hua Hu The spectrum of overlapping anti-NMDAR encephalitis and demyelinating syndromes: a systematic review of presentation, diagnosis, management, and outcomes Annals of Medicine Anti-NMDAR encephalitis multiple sclerosis myelin oligodendrocyte glycoprotein antibody-associated disease neuromyelitis optica spectrum disorder overlapping syndrome |
| title | The spectrum of overlapping anti-NMDAR encephalitis and demyelinating syndromes: a systematic review of presentation, diagnosis, management, and outcomes |
| title_full | The spectrum of overlapping anti-NMDAR encephalitis and demyelinating syndromes: a systematic review of presentation, diagnosis, management, and outcomes |
| title_fullStr | The spectrum of overlapping anti-NMDAR encephalitis and demyelinating syndromes: a systematic review of presentation, diagnosis, management, and outcomes |
| title_full_unstemmed | The spectrum of overlapping anti-NMDAR encephalitis and demyelinating syndromes: a systematic review of presentation, diagnosis, management, and outcomes |
| title_short | The spectrum of overlapping anti-NMDAR encephalitis and demyelinating syndromes: a systematic review of presentation, diagnosis, management, and outcomes |
| title_sort | spectrum of overlapping anti nmdar encephalitis and demyelinating syndromes a systematic review of presentation diagnosis management and outcomes |
| topic | Anti-NMDAR encephalitis multiple sclerosis myelin oligodendrocyte glycoprotein antibody-associated disease neuromyelitis optica spectrum disorder overlapping syndrome |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2025.2517813 |
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