PMID- 30787630
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220331
IS  - 1178-7090 (Print)
IS  - 1178-7090 (Electronic)
IS  - 1178-7090 (Linking)
VI  - 12
DP  - 2019
TI  - Emerging role of prodromal headache in patients with anti-N-methyl-D-aspartate 
      receptor encephalitis.
PG  - 519-526
LID - 10.2147/JPR.S189301 [doi]
AB  - BACKGROUND: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients 
      often present with psychiatric symptoms, cognitive dysfunction, epilepsy and 
      memory deficits. A previous study has suggested that headache can occurr during 
      the early stages of anti-NMDAR encephalitis. However, the exact association 
      between headache and anti-NMDAR encephalitis has hardly been investigated, apart 
      from a few case studies. This is probably due to the severity of encephalitis 
      symptoms, and the mechanism underlying headache-associated anti-NMDAR 
      encephalitis remains largely unclear. OBJECTIVE: This study aimed to investigate 
      the role of prodromal headache in 28 patients diagnosed with anti-NMDAR 
      encephalitis. METHODS: Clinical data related to the prodromal headache 
      characteristics of anti-NMDAR encephalitis patients were prospectively collected 
      from January first 2017 to June first 2018. Autoimmune antibodies in the 
      cerebrospinal fluid (CSF) of anti-NMDAR encephalitis patients were detected by an 
      indirect immunofluorescence staining kit. The differences between age, sex, 
      clinical symptoms (fever, epilepsy, psychiatric symptoms, cognitive impairment, 
      disturbance of consciousness), CSF, brain MRI abnormalities, and modified Rankin 
      Scale (mRS) score were compared between patients with and without headache. In 
      addition, the association of headache severity with brain MRI abnormalities, 
      antibody titers, and mRS score was examined. RESULTS: Twenty-eight patients with 
      anti-NMDAR encephalitis (median, 29 years; range, 15-62 years) reported headache. 
      Among them, 18 (64%) were female, 24 (86%) had fever, 21 (75%) were positive for 
      serum virus antibody, 19 (68%) had severe pain intensity (scored 4-7 out of 10 on 
      the visual analog scale), 18 (64%) presented with pulsating character, and 5 
      (18%) patients accompanied by vomiting. Moreover, headache was detected in the 
      frontal lobe of 14 (50%) patients and temporal lobe of 12 (43%) patients. 
      Encephalitic symptoms (psychiatric symptoms, cognitive dysfunction, epilepsy, and 
      memory deficits) appeared in 23 patients at average 5.5 days (range, 1-21 days) 
      followed by headache attack. In five patients, the headache was lasted for 21 
      days. CONCLUSION: Prodromal headache is commonly found in the temporal lobe and 
      frontal lobe of young patients, and hardly accompanied by vomiting. Headache is 
      rapidly substituted by encephalitis symptoms in the majority of patients, while 
      gradually relieved in a few patients after the recovering from encephalitis 
      symptoms. The results strongly suggest that the NR1 subunit of NMDAR is involved 
      in prodromal headache. In sum, the symptom of prodromal headache is crucial for 
      the diagnosis of anti-NMDAR encephalitis.
FAU - Ma, Congcong
AU  - Ma C
AD  - Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou 450052, Henan Province, China Email lianyajun369@yeah.net.
FAU - Wang, Chengze
AU  - Wang C
AD  - Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou 450052, Henan Province, China Email lianyajun369@yeah.net.
FAU - Zhang, Qiaoman
AU  - Zhang Q
AD  - Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou 450052, Henan Province, China Email lianyajun369@yeah.net.
FAU - Lian, Yajun
AU  - Lian Y
AD  - Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou 450052, Henan Province, China Email lianyajun369@yeah.net.
LA  - eng
PT  - Journal Article
DEP - 20190130
PL  - New Zealand
TA  - J Pain Res
JT  - Journal of pain research
JID - 101540514
PMC - PMC6365221
OTO - NOTNLM
OT  - autoimmune encephalitis
OT  - headache
OT  - immunology
COIS- Disclosure Dr Yajun Lian has received grants from the National Natural Science 
      Foundation of China, entitled "Role and mechanism of mfn2-regulated 
      mitochondria-associated endoplasmic reticulum structural function changes in 
      epileptic nerve injury" (project approval number: 81771397). The authors report 
      no other conflicts of interest in this work.
EDAT- 2019/02/23 06:00
MHDA- 2019/02/23 06:01
PMCR- 2019/01/30
CRDT- 2019/02/22 06:00
PHST- 2019/02/22 06:00 [entrez]
PHST- 2019/02/23 06:00 [pubmed]
PHST- 2019/02/23 06:01 [medline]
PHST- 2019/01/30 00:00 [pmc-release]
AID - jpr-12-519 [pii]
AID - 10.2147/JPR.S189301 [doi]
PST - epublish
SO  - J Pain Res. 2019 Jan 30;12:519-526. doi: 10.2147/JPR.S189301. eCollection 2019.