Introduction: The Challenge of Prognostication in Anti-NMDAR Encephalitis
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis represents one of the most common causes of autoimmune encephalitis, characterized by a complex constellation of psychiatric symptoms, cognitive deficits, seizures, and autonomic instability. While the disease is notoriously severe—often requiring prolonged intensive care—it is also uniquely treatable. However, the clinical trajectory of patients varies significantly. Some achieve full recovery with first-line immunotherapy, while others suffer from persistent cognitive impairment or require years of rehabilitation.
For clinicians, the ability to predict these outcomes early in the disease course is critical. Early identification of patients unlikely to respond to standard first-line therapies (corticosteroids, intravenous immunoglobulin, or plasma exchange) could facilitate the timely initiation of second-line agents like rituximab or cyclophosphamide. The newly developed NEOS2 score, validated in a large international cohort, aims to provide this predictive clarity using data available at the time of diagnosis.
