The Japanese Journal of Rehabilitation Medicine

　Anti-N-methyl-D-aspartate（NMDA）receptor（NMDAR）encephalitis is an autoimmune disorder typically involving ovarian teratomas and a severe neuropsychiatric disorder involving prominent memory and behavioral deficits. The purpose of this study was to evaluate the clinical symptoms and outcomes of six patients（one male, five female；age：20 to 47 years）with autoantibody-associated NMDAR encephalitis, who underwent comprehensive rehabilitation in our hospital. The five female patients underwent ovarian teratoma removal. At the beginning of rehabilitation, the mean score on the Rivermead Behavioural Memory Test was 16.7, and prospective memory was preserved in two patients and was recovered in two patients. The mean Wechsler Memory Scale-Revised score of the six patients significantly increased after rehabilitation, which suggested good recovery, compared to that in the patients with herpes encephalitis. However, in the chronic state, two patients showed persistent short-term memory disturbances that required a compensatory approach and employment assistance. Four patients who were treated with convalescent cognitive rehabilitation 4.5 months after onset improved in 4 months and showed good prognoses. Three returned to work, one returned to school, and two lived independently. Patients with anti-NMDAR encephalitis respond to immunotherapy, but they exhibit persistent cognitive deficits that are related to the distribution and functional role of NMDARs in the human brain. Early intervention for the short-term memory disturbances in convalescent rehabilitation, chronic interventions for the persistent memory disturbances, and preservation of perceptive memory are important to facilitate future employment.

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Increased average life expectancy results in increasing numbers of elderly persons and medical expenses. In this study, changes in rehabilitation-related medical expenses were investigated from 2006 to 2014. Data were obtained via the “Survey of Medical Care Activities in Public Health Insurance.” The number of times and points that demanded medical service fees for “rehabilitation” were examined according to disease group.
In 2014, the rehabilitation point per day was 5.3％ for inpatient medical care（2.9％ per year increase）and 1.3％ for outpatient medical care（9.2％ per year increase). Proportions of time according to disease group were 48.9％ for cerebrovascular disease rehabilitation, 46.8％ for musculoskeletal rehabilitation, 2.4％ for respiratory rehabilitation, 1.4％ for cardiovascular disease rehabilitation, and 0.4％ for cancer rehabilitation. Proportions of points according to disease group were 55.8％ for cerebrovascular disease rehabilitation, 39.8％ for musculoskeletal rehabilitation, 2.4％ for respiratory rehabilitation, 1.7％ for cardiovascular disease rehabilitation, and 0.4％ for cancer rehabilitation.
The number of times and points increased in each disease group except for disuse syndrome in cerebrovascular disease rehabilitation. Disuse syndrome for times and points were 16.0％（30.3％ per year decrease）and 12.1％（46.4％ per year decrease）respectively；the total number of times rose 3.4％ while the total number of points rose 2.7％ per year. The early addition increased annually for number of times and points together in each disease group except for cerebrovascular disease rehabilitation. Rehabilitation-related medical expenses increased annually and the growth rate was substantial for all medical expenses, indicating an increase in rehabilitation medical care.

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