Ovarian teratoma-associated Anti-NMDAR encephalitis in women with first-time neuropsychiatric symptoms: A meta-analysis and systematic review of reported cases.

OBJECTIVE

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is frequently associated with ovarian teratomas. The diverse clinical presentations and several stages of disease development pose a significant diagnostic challenge for clinicians. The main objective of this research was to show the prevalence of neuropsychiatric symptoms of ovarian-teratoma-associated anti-NMDAR encephalitis and to highlight the importance of multidisciplinary collaboration in the diagnosis, treatment, and prevention of disease progression.

METHODS

Literature searches were carried out using PubMed, Scopus, and Web of Science Core Collection. The following data were retrieved: authors' names, year of publication, type of study, number and age of patients included, diagnostic methods of disease evaluation, prevalence of anti-NMDAR antibodies, psychiatric manifestations, other symptoms, initial diagnosis, treatment strategies, and histopathology results. Data analyses were performed and considered statistically significant when  < 0.05.

RESULTS

Our study included 98 female patients with encephalitis associated with a teratoma. The study group reported specific symptoms more often than expected in the general population ( < 0.05). The incidence of seizures deviated most from rates in the general population. The major significant differences were observed in cases of psychosis, seizures, hypoventilation, aphasia, and coma.

CONCLUSIONS

Teratoma-associated anti-NMDAR encephalitis diagnosis should be systematically investigated in patients presenting with first-time psychotic episodes. Prompt diagnosis and treatment are imperative for prevention of disease progression and better outcomes. Screening and identification of anti-NMDAR antibodies and considering the association of ovarian teratoma and neuropsychiatric symptoms suggesting encephalitis are critical for establishing the proper diagnosis.