Two-thirds still have symptoms after NMDA receptor encephalitis

Design

Cross-sectional study with 1:1 matched controls and structural MRI

Population

70 patients after NMDA receptor encephalitis, Berlin, 2011–2021

Primary outcome

Residual symptoms, cognition and cortical morphological complexity

Effect

67% had residual symptoms: memory 61%, psychiatric 36%; mRS median 5 at peak vs 1 later

This Lancet Psychiatry cross-sectional study, published on 1 September, assessed 70 patients referred to Berlin after NMDA receptor encephalitis, a median of 22 months from onset, against 70 matched controls. Almost all had been severely unwell at peak (median modified Rankin 5) and most recovered substantially (median 1).

Even so, 67% still had symptoms: memory problems in 61% and psychiatric symptoms in 36%. In those with persisting problems, the psychiatric picture had shifted from psychosis at peak to a mainly affective one later. MRI showed reduced cortical complexity in both hippocampi and a fronto-cingulo-temporal network, more so in patients with persisting symptoms.

For psychiatrists, the practical point is that patients often arrive after the neurology team has discharged them as recovered. Low mood, anxiety and memory complaints in this group may be sequelae of the encephalitis rather than a new primary disorder, and they need structured follow-up rather than being reset to a first-episode pathway.

• Ask about previous encephalitis in young adults, mostly women, presenting with new mood symptoms or memory complaints.
• Expect depression and anxiety, not psychosis, as the usual psychiatric picture after the acute phase.
• Check memory formally; it was the most common residual problem.
• Plan joint follow-up with neurology rather than treating residual symptoms as a new primary illness.

Why it matters

A good Rankin score hides the depression and memory loss that psychiatry is left to manage.

Don't overread it

The imaging is cross-sectional; it shows association with symptoms, not a validated prognostic test.

The statistics, in plain English

The Rankin and CASE scores measure disability; a fall from a median of 5 to 1 means most patients went from severe dependence to few restrictions. That improvement can coexist with persistent memory and mood symptoms, which these scales capture poorly.

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