Spatial and Ecological Factors Modulate the Incidence of Anti-NMDAR Encephalitis-A Systematic Review.

Content Provider	Europe PMC
Author	Alentorn, Agustí Berzero, Giulia Alexopoulos, Harry Tzartos, John Reyes Botero, Germán Morales Martínez, Andrea Muñiz-Castrillo, Sergio Vogrig, Alberto Joubert, Bastien García Jiménez, Francisco A. Cabrera, Dagoberto Tobon, José Vladimir Delgado, Carolina Sandoval, Patricio Troncoso, Mónica Galleguillos, Lorna Giry, Marine Benazra, Marion Hernández Verdin, Isaias Dade, Maëlle Picard, Géraldine Rogemond, Véronique Weiss, Nicolas Dalakas, Marinos C. Boëlle, Pierre-Yves Delattre, Jean-Yves Honnorat, Jérôme Psimaras, Dimitri
Editor	Matrone, Carmela
Copyright Year	2023
Abstract	Anti-NMDAR encephalitis has been associated with multiple antigenic triggers (i.e., ovarian teratomas, prodromal viral infections) but whether geographic, climatic, and environmental factors might influence disease risk has not been explored yet. We performed a systematic review and a meta-analysis of all published papers reporting the incidence of anti-NMDAR encephalitis in a definite country or region. We performed several multivariate spatial autocorrelation analyses to analyze the spatial variations in the incidence of anti-NMDA encephalitis depending on its geographical localization and temperature. Finally, we performed seasonal analyses in two original datasets from France and Greece and assessed the impact of temperature using an exposure-lag-response model in the French dataset. The reported incidence of anti-NMDAR encephalitis varied considerably among studies and countries, being higher in Oceania and South America (0.2 and 0.16 per 100,000 persons-year, respectively) compared to Europe and North America (0.06 per 100,000 persons-year) (p < 0.01). Different regression models confirmed a strong negative correlation with latitude (Pearson’s R = −0.88, p < 0.00001), with higher incidence in southern hemisphere countries far from the equator. Seasonal analyses showed a peak of cases during warm months. Exposure-lag-response models confirmed a positive correlation between extreme hot temperatures and the incidence of anti-NMDAR encephalitis in France (p = 0.03). Temperature analyses showed a significant association with higher mean temperatures and positive correlation with higher ultraviolet exposure worldwide. This study provides the first evidence that geographic and climatic factors including latitude, mean annual temperature, and ultraviolet exposure, might modify disease risk.
Journal	Biomedicines
Volume Number	11
PubMed Central reference number	PMC10295747
Issue Number	6
PubMed reference number	37371620
e-ISSN	22279059
DOI	10.3390/biomedicines11061525
Language	English
Publisher	MDPI
Publisher Date	2023-05-25
Access Restriction	Open
Rights License	Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). © 2023 by the authors.
Subject Keyword	anti-NMDAR encephalitis geoepidemiology seasonality
Content Type	Text
Resource Type	Article
Subject	Medicine Biochemistry, Genetics and Molecular Biology