Evidence map›Paper›PMID 35790561›Full record

SynthesisJournal of neurology2022

The clinical relevance of serum versus CSF NMDAR autoantibodies associated exclusively with psychiatric features: a systematic review and meta-analysis of individual patient data.

Graham Blackman, Mao Fong Lim, Thomas Pollak, Adam Al-Diwani, Mkael Symmonds, Asif Mazumder, Ben Carter, Sarosh Irani, Anthony David

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Review
  4. Review
  5. Article
  6. Article
  7. Article
  8. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Graham Blackman *Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, London, UK. graham.blackman@kcl.ac.uk.ORCID http://orcid.org/0000-0001-7025-8670
Mao Fong Lim *Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, London, UK.ORCID https://orcid.org/0000-0003-3293-2219
Thomas PollakDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, London, UK.ORCID https://orcid.org/0000-0002-6171-0810
Adam Al-DiwaniOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0001-6596-7579
Mkael SymmondsDivision of Clinical Neurology, John Radcliffe Hospital, Oxford, UK.ORCID https://orcid.org/0000-0001-9903-5083
Asif MazumderDepartment of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK.ORCID https://orcid.org/0000-0002-1451-8770
Ben CarterDepartment of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID https://orcid.org/0000-0003-0318-8865
Sarosh IraniOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0002-7667-9748
Anthony DavidUCL Institute of Mental Health, University College London, London, UK.ORCID https://orcid.org/0000-0003-0967-774X

Funding

Medical Research Council MR/V007173/1
6 · The paper itself

Abstract

backgroundA variety of psychiatric syndromes are associated with NMDAR autoantibodies; however, their clinical relevance when only present in the serum is unclear. We explored whether patients with CSF NMDAR autoantibodies could be distinguished from patients with serum-only NMDAR autoantibodies.

methodsThe electronic databases MEDLINE, EMBASE, PubMed, and PsycINFO were searched. Articles reporting adult patients with isolated psychiatric features and positive for NMDAR autoantibodies with relevant investigations were included. Patient level meta-analysis compared patients positive for CSF NMDAR autoantibodies with patients positive for serum NMDAR autoantibodies, but negative for CSF NMDAR autoantibodies. Dichotomous data were analysed using crude odds ratios (OR), whilst continuous data were analysed using Mann-Whitney Test (U). The protocol was prospectively registered (CRD42018082210).

resultsOf 4413 publications, 42 were included, reporting 79 patients. Median age was 34 years (IQR 19 years); 56% (45/79) were female and 24% (16/68) had a tumour. In total, 41 patients were positive for CSF autoantibodies and 20 were positive for serum-only autoantibodies. Patients with CSF autoantibodies were significantly more likely to be female (p < 0.001) and have a rapid (< 3 month) onset of symptoms (p = 0.02) than patients with serum-only autoantibodies. They were also more likely to present with psychosis (p < 0.001), exhibit EEG (p = 0.006), MRI (p = 0.002), and CSF (p = 0.001) abnormalities, but less likely to present with insomnia (p = 0.04).

conclusionsPatients with an isolated psychiatric syndrome with CSF NMDAR autoantibodies can potentially be distinguished from those with serum-only NMDAR autoantibodies based on clinicodemographic and investigation findings.

Indexed as

Anti-N-Methyl-D-Aspartate Receptor EncephalitisPsychotic DisordersAdultAutoantibodiesFemaleHumansMaleReceptors, N-Methyl-D-AspartateAutoantibodiesReceptors, N-Methyl-D-AspartateAntineuronal antibodiesAutoimmune encephalitisAutoimmune psychosisMeta-analysisNMDARPsychosis

Identifiers

PMID35790561
PMCPMC9467941

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.