背景:抗N-甲基-D-天冬氨酸受体脑炎(ANMDARE)是一种神经免疫疾病,经常通过免疫疗法改善。抗精神病药物的对症治疗在精神症状占主导地位的早期阶段很常见。它们的使用与严重的副作用有关,包括抗精神病药恶性综合征(NMS)。抗精神病药物不良反应的观察,引起了对NMS的怀疑,已被列为可能的自身免疫性精神病的标准。
方法:这项病例对照研究包括在转诊到墨西哥国家神经病学和神经外科研究所之前接受抗精神病药物治疗的患者,他们被诊断为有明确的ANMDARE,以及在转诊前没有接受抗精神病药物治疗的ANMDARE患者.用于测量抗精神病药不良反应的神经系统和系统特征,引起了对NMS的怀疑,在两组中都进行了测量,包括运动障碍,自主神经不稳定,广义刚度,肌酸磷酸激酶浓度升高,还有热疗.使用逻辑回归分析来确定先前使用抗精神病药与NMS样反应发生之间的关系。
结果:共112例明确ANMDARE患者纳入研究。50名患者在转诊至我们机构之前接受了抗精神病药。在这个群体中,36名患者(72%)最初被归类为有不良反应,引起了对NMS的怀疑,具有以下特征:运动障碍(64%),自主神经不稳定(58%),广义刚度(52%),肌酸磷酸激酶浓度升高(50%),和热疗(14%)。6例患者符合NMS标准(12%)。与在临床评估之前未接受抗精神病药的患者的比较,在运动障碍的频率方面,两组之间没有显着差异。自主神经不稳定,广义刚度,肌酸磷酸激酶浓度升高,或者热疗.在不同的抗精神病药物中,与未接受抗精神病药物治疗的患者相比,只有氟哌啶醇与全身僵硬显著相关.
结论:我们的研究支持先前关于自主神经功能障碍高频率的观察,热疗,心动过速,刚性,服用抗精神病药物后,抗NMDAR脑炎患者的CPK水平升高。然而,我们的研究并不表明非典型抗精神病药物和这些神经症状的发作之间存在因果关系,因为它们在未接受抗精神病药物治疗的患者组中同样常见。
BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE) is a neuroimmunological disorder that frequently improves with immunotherapy. Symptomatic treatment with antipsychotics is common in the early stages when psychiatric symptoms predominate, and their use has been associated with serious side effects including neuroleptic malignant syndrome (NMS). The observation of an adverse response to antipsychotics, raising the suspicion of NMS, has been included as a criterion for possible autoimmune psychosis.
METHODS: This case-control
study included patients who received antipsychotics before referral to the National Institute of Neurology and Neurosurgery of Mexico, where they were diagnosed as having definite ANMDARE, and patients with ANMDARE who did not receive antipsychotics before referral. The neurologic and systemic features that are used to measure an adverse response to antipsychotics, raising the suspicion of NMS, were measured in both groups, including akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, and hyperthermia. A logistic regression analysis was used to determine the relationship between the previous use of antipsychotics and the occurrence of NMS-like reactions.
RESULTS: A total sample of 112 patients with definite ANMDARE were included in the
study. Fifty patients received antipsychotics before being referred to our institution. In this group, thirty-six patients (72%) were initially classified as having an adverse response, raising the suspicion of NMS, with the following features: akinesia (64%), autonomic instability (58%), generalized rigidity (52%), elevated concentrations of creatine phosphokinase (50%), and hyperthermia (14%). Six patients fulfilled the criteria for NMS (12%). The comparison with patients who did not receive antipsychotics before the clinical assessment did not show a significant difference between groups regarding the frequency of akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, or hyperthermia. Among different antipsychotics, only haloperidol was significantly associated with generalized rigidity as compared to patients who did not receive antipsychotics.
CONCLUSIONS: Our
study supports previous observations about the high frequency of autonomic dysfunction, hyperthermia, tachycardia, rigidity, and elevated creatine phosphokinase levels in patients with anti-NMDAR encephalitis following the administration of antipsychotic medications. Nevertheless, our
study does not suggest a causal link between atypical antipsychotics and the onset of these neurological symptoms, as they were equally frequent among the group of patients who did not receive antipsychotic treatment.