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

• Published in: Biomedicines Vol. 11; no. 6; p. 1525
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 25.05.2023; MDPI
• Subjects: Air pollution; Analysis; anti-NMDAR encephalitis; Autoimmune diseases; Datasets; Encephalitis; Environmental factors; Estimates; geoepidemiology; Glutamic acid receptors; Health aspects; Latitude; Localization; Meta-analysis; N-Methyl-D-aspartic acid receptors; Population; Regression analysis; seasonality; Spatial variations; Systematic Review; Temperature effects; Trends; Greece; Colombia; France; Chile; seasonality; anti-NMDAR encephalitis; geoepidemiology
• ISSN: 2227-9059; 2227-9059
• DOI: 10.3390/biomedicines11061525

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) ( < 0.01). Different regression models confirmed a strong negative correlation with latitude (Pearson's R = -0.88, < 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 ( = 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.