NEOS2 score predicts anti-NMDAR encephalitis outcomes at diagnosis

medwireNews: Researchers have developed an updated version of the anti-NMDAR Encephalitis One-Year Functional Status (NEOS) score for predicting short- and long-term outcomes at the point of diagnosis. The currently available anti-NMDAR Encephalitis One-Year Functional Status (NEOS) score predicts independence at 1 year, “but only after one month of first-line treatment,” noted Juliette Brenner (Erasmus University Medical Center, Rotterdam, the Netherlands). At the 10th Congress of the European Academy of Neurology held in Helsinki, Finland, Brenner introduced the NEOS2, which together with colleagues she assessed to see if it could accurately predict 1-year outcome in patients with anti-NMDAR encephalitis at the point of diagnosis and identify those who are most likely to improve with first-line immunotherapy or need second-line therapy. The score was developed and validated using an international cohort of 712 participants with anti-NMDAR encephalitis from five countries – Spain, France, Germany, Japan, and the Netherlands. The group had a mean age of 23 years, 80% were women, and 30% had a tumor. Most (95%) of the patients received first-line treatment, including intravenous steroids or immunoglobulin G, while 60% receive second-line treatment with rituximab or cyclophosphamide. Outcomes were good for 80% of the patients who were independent after a year, with 74% going back to work or school at 3 years. The researchers identified five risk factors at diagnosis that on multivariate analysis were significantly associated with a good outcome (modified Rankin Scale score [mRS]≤2) at 1 year. These were being 36 years of age or older versus younger at diagnosis (odds ratio [OR]=0.93), having a movement disorder (OR=0.39), needing admission to an intensive care unit ([ICU]; OR=0.34), treatment being delayed by 2 weeks or more (OR=0.52), and the presence of elevated leukocytes in cerebrospinal fluid (OR=0.66). Brenner noted that there was also an effect of an interaction between delay and leukocyte count, with a high leukocyte count in the first 2 weeks of symptom onset associated with a particularly poor prognosis, compared with after 2 weeks. “With these variables we could predict the outcome after 1 year with the same accuracy as the original NEOS score, but we could predict it already at the time of diagnosis,” highlighted Brenner. The two variables included in the NEOS2 score not included in the NEOS score are age at diagnosis and the interaction between delay and leukocyte count, she explained. Brenner continued: “With the inclusion of these two new variables, we could get rid of the effect of first-line therapy as a predictor for outcome.” The same variables also predicted who would respond to first-line treatment, with the exception of age for this outcome, and who would return to work or school at 3 years. The researchers made their model more clinically applicable by allocating scores to each of the categories of the predictive variables, giving scores of 0–16 points for outcome at 1 year, 0–10 points for response to first-line treatment, and 0–14 points for return to work or school at 3 years. A very low NEOS2 score would mean an individual had a very high chance of a good outcome after 1 year, for instance 100% with a score of 0, and a very high score of 16 points would mean an individual only had 10 to 20% chance of a good outcome, said Brenner. The same model applies for predicting the other outcomes. The presenter commented that the goal is “to identify patients who are not likely to improve with first-line therapy and we can maybe treat them more aggressively sooner and then maybe we can also increase their long-term outcomes.” She added: “We expect that this could work because it is the same variables predicting both.” medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group EAN Congress 2024; Helsinki, Finland: 29 June - 2 July

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NEOS2 score predicts anti-NMDAR encephalitis outcomes at diagnosis

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