ArticleFrontiers in immunology2026
Peripheral nervous system involvement accompanies central nervous system involvement in anti-N-methyl-D-aspartate receptor encephalitis.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most common autoimmune encephalitis, primarily affecting the central nervous system (CNS) and typically presenting with neuropsychiatric symptoms. However, emerging evidence suggests that peripheral nervous system (PNS) involvement may also occur in some cases. Objective: To investigate the clinical and neuro-electrophysiological characteristics of PNS involvement in patients with positive anti-NMDAR antibodies in cerebrospinal fluid (CSF). Methods: We retrospectively reviewed all patients with CSF-confirmed anti-NMDAR encephalitis at the Second Affiliated Hospital of Guangzhou Medical University between 2016 and 2025. Collected data included initial symptoms and disease severity, CSF and serum test results, magnetic resonance imaging (MRI) and neuro-electrophysiological findings, primary treatment regimens, presence of coexisting autoimmune disorders, and clinical outcomes. Results: Among the 46 patients with anti-NMDAR encephalitis, 9 patients (19.6%) exhibited PNS involvement. The average age of onset in this subgroup with PNS involvement were significantly older than those with CNS involvement only (mean ± SD: 36.2 ± 18.9 years vs. 24.6 ± 12.4 years; Conclusion: PNS involvement in anti-NMDAR encephalitis is not uncommon and most frequently manifests as acute or subacute limb weakness. Neuro- electrophysiological abnormalities predominantly involve motor conduction pathways and proximal nerve roots. This is a single-center retrospective study with a small sample size. Large-sample prospective studies are needed to further validate the findings.
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