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Autoimmune Anti-NMDA Receptor Encephalitis

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Encephalitis with antibodies to glutamate NMDA receptors (anti-NMDA receptor encephalitis, ANRE) is a relatively common form of autoimmune encephalitis. Clinical symptoms at onset are similar to the symptoms of exacerbation of schizophrenia, such that these patients are often hospitalized in psychiatric institutions. Considering the high lethality of this condition, and also its potential curability, detection of ANRE is an important clinical task. We present here the first laboratory confirmed case of ANRE in the Russian literature. Difficulties preventing the prompt resolution of the condition are presented, along with criteria for its diagnosis and a treatment algorithm.

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References

  1. R. Vitaliani, W. Mason, B. Ances, et al., “Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma,” Ann. Neurol., 58, No. 4, 594–604 (2005), doi: https://doi.org/10.1002/ana.20614.

    Article  PubMed  PubMed Central  Google Scholar 

  2. J. Dalmau, E. Tüzün, H. Wu, et al., “Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma,” Ann. Neurol., 61, No. 1, 25–36 (2007), doi: https://doi.org/10.1002/ana.21050.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. C. Finke, U. Kopp, H. Pruss, et al., “Cognitive deficits following anti-NMDA receptor encephalitis,” J. Neurol. Neurosurg. Psychiatr., 83, No. 2, 195–198 (2011), doi: https://doi.org/10.1136/jnnp-2011-300411.

    Article  Google Scholar 

  4. F. Graus, “Anti-Hu-associated paraneoplastic encephalomyelitis: analysis of 200 patients,” Brain, 124, No. 6, 1138–1148 (2001), doi: https://doi.org/10.1093/brain/124.6.1138.

    Article  PubMed  CAS  Google Scholar 

  5. S. Irani, S. Alexander, P. Waters, et al., “Antibodies to Kv1 potassium channel complex proteins leucine-rich, glioma inactivated 1 protein and contactin-associated protein-2 in limbic encephalitis, Morvan’s syndrome and acquired neuromyotonia,” Brain, 133, No. 9, 2734–2748 (2010), doi: https://doi.org/10.1093/brain/awq213.

    Article  PubMed  PubMed Central  Google Scholar 

  6. H. Pruss, J. Dalmau, L. Harms, et al., “Retrospective analysis of NMDA receptor antibodies in encephalitis of unknown origin,” Neurology, 75, No. 19, 1735–1739 (2010), doi: https://doi.org/10.1212/WNL.0b013e3181fc2a06.

    Article  PubMed  CAS  Google Scholar 

  7. J. Granerod, H. Ambrose, R. Cunningham, et al., “Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study,” Lancet Infect. Dis., 10, No. 12, 835–844 (2010), doi: https://doi.org/10.1016/S1473-3099(10)70222-X.

    Article  PubMed  Google Scholar 

  8. T. Iizuka, F. Sakai, T. Ide, et al., “Anti-NMDA receptor encephalitis in Japan: Long-term outcome without tumor removal,” Neurology, 70, No. 7, 504–511, (2007) doi.10.1212/01.wnl.0000278388.90370.c3.

  9. L. Sansing, E. Tüzün, M. Ko, et al., “A patient with encephalitis associated with NMDA receptor antibodies,” Nat. Clin. Pract. Neurol., 3, No. 5, 291–296 (2007), doi: https://doi.org/10.1038/ncpneuro0493.

    Article  PubMed  PubMed Central  Google Scholar 

  10. J. Dalmau, E. Lancaster, E. Martinez-Hernandez, et al., “Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis,” Lancet Neurol., 10, No. 1, 63–74 (2011), doi: https://doi.org/10.1016/S1474-4422(10)70253-2.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. J. Dalmau, A. Gleichman, E. Hughes, et al., “Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies,” Lancet Neurol., 7, No. 12, 1091–1098 (2008), doi: https://doi.org/10.1016/S1474-4422(08)70224-2.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. C. Gitiaux, H. Simonnet, M. Eisermann, et al., “Early electro-clinical features may contribute to diagnosis of the anti-NMDA receptor encephalitis in children,” Clin. Neurophysiol., 124, No. 12, 2354–2361 (2013), doi: https://doi.org/10.1016/j.clinph.2013.05.023.

    Article  PubMed  Google Scholar 

  13. T. Iizuka, F. Sakai, T. Ide, et al., “Anti-NMDA receptor encephalitis in Japan: Long-term outcome without tumor removal,” Neurology, 70, No. 7, 504–511 (2007), doi: https://doi.org/10.1212/01.wnl.0000278388.90370.c3.

    Article  PubMed  PubMed Central  Google Scholar 

  14. M. Maeder-Ingvar, J. Prior, S. Irani, et al., “FDGPET hyperactivity in basal ganglia correlating with clinical course in anti-NMDA-R antibodies encephalitis,” J. Neurol. Neurosurg. Psychiatry, 82, No. 2, 235–236 (2010), doi: https://doi.org/10.1136/jnnp.2009.198697.

    Article  PubMed  Google Scholar 

  15. S. Pillai, D. Gill, R. Webster, et al., “Cortical hypometabolism demonstrated by PET in relapsing NMDA receptor encephalitis,” Pediatr. Neurol., 43, No. 3, 217–220 (2010), doi: https://doi.org/10.1016/j.pediatrneurol.2010. 04.019.

  16. V. Llorens, I. Gabilondo, J. Gómez-Esteban, et al., “Abnormal multifocal cerebral blood flow on Tc-99m HMPAO SPECT in a patient with anti-NMDA receptor encephalitis,” J. Neurol., 257, No. 9, 1568–1569 (2010), doi: https://doi.org/10.1007/s00415-010-5546-z.

    Article  PubMed  Google Scholar 

  17. N. Florance, R. Davis, C. Lam, et al., “Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents,” Ann. Neurol., 66, No. 1, 11–18 (2009), doi: https://doi.org/10.1002/ana.21756.

    Article  PubMed  PubMed Central  Google Scholar 

  18. S. Irani, K. Bera, P. Waters, et al., “N-methyl-D-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexes,” Brain, 133, No. 6, 1655–1667 (2010), doi: https://doi.org/10.1093/brain/awq113.

    Article  PubMed  PubMed Central  Google Scholar 

  19. M. Seki, S. Suzuki, T. Iizuka, et al., “Neurological response to early removal of ovarian teratoma in anti- NMDAR encephalitis,” J. Neurol. Neurosurg. Psychiatry, 79, No. 3, 324–326 (2008), doi: https://doi.org/10.1136/jnnp.2007.136473.

    Article  PubMed  CAS  Google Scholar 

  20. A. Lebas, B. Husson, A. Didelot, et al., “Expanding spectrum of encephalitis with NMDA receptor antibodies in young children,” J. Child Neurol., 25, No. 6, 742–745 (2009), doi: https://doi.org/10.1177/0883073809343319.

    Article  PubMed  Google Scholar 

  21. M. Zandi, S. Irani, G. Follows, et al., “Limbic encephalitis associated with antibodies to the NMDA receptor in Hodgkin lymphoma,” Neurology, 73, No. 23, 2039–2040 (2009), doi: https://doi.org/10.1212/wnl.0b013e3181c55e9b.

    Article  PubMed  CAS  Google Scholar 

  22. A. Poduval, Z. Antal, T. Lee, et al., “Immune-mediated encephalitis and virilization in association with a mature cystic ovarian teratoma in an adolescent girl,” Horm. Res., 72, No. 4, 252–256 (2009), doi: https://doi.org/10.1159/000236087.

    Article  PubMed  CAS  Google Scholar 

  23. M. Gable, S. Gavali, A. Radner, et al., “Anti-NMDA receptor encephalitis: report of ten cases and comparison with viral encephalitis,” Eur. J. Clin. Microbiol. Infect. Dis., 28, No. 12, 421–1429 (2009), doi: https://doi.org/10.1007/s10096-009-0799-0.

    Article  Google Scholar 

  24. S. Baltagi, M. Shoykhet, K. Felmet, et al., “Neurological sequelae of 2009 influenza A (H1N1) in children: A case series observed during a pandemic,” Pediatr. Crit. Care Med., 11, No. 2, 179–184 (2010), doi: https://doi.org/10.1097/pcc.0b013e3181cf4652.

    Article  PubMed  Google Scholar 

  25. C. Hofmann, M. O. Baur, and H. Schroten, “Anti-NMDA receptor encephalitis after TdaP-IPV booster vaccination: cause or coincidence?” J. Neurol., (2010), doi:https://doi.org/10.1007/ s00415-010-5757-3.

  26. J. Greenlee and M. Cortez, “Faculty of 1000 evaluation for N-methyl-D-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexes,” F1000 – Post-Pub lication Peer Review of the Biomedical Literature, doi: 10.3410/f.11778958.12871058.

  27. L. Wong-Kisiel, T. Ji, D. Renaud, S. Kotagal, et al., “Response to immunotherapy in a 20-month-old boy with anti-NMDA receptor encephalitis,” Neurology, 74, No. 19, 1550–1551 (2010), doi: https://doi.org/10.1212/wnl.0b013e3181dd41a1.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. H. Ishiura, S. Matsuda, M. Higashihara, et al., “Response of anti-NMDA receptor encephalitis without tumor to immunotherapy including rituximab,” Neurology, 71, No. 23, 1921–1923 (2008), doi: https://doi.org/10.1212/01.wnl.0000336648.43562.59.

    Article  PubMed  CAS  Google Scholar 

  29. P. Acién, M. Acién, E. Ruiz-Maciá, and C. Martín-Estefanía, “Ovarian teratoma-associated anti-NMDAR encephalitis: a systematic review of reported cases,” Orphanet J. Rare Dis., 9, No. 1, 78–82 (2014), doi: https://doi.org/10.1186/s13023-014-0157-x.

    Article  Google Scholar 

  30. W. Splinter and N. Eipe, “Anti-NMDA receptor antibodies encephalitis,” Pediatric Anesthesia, 19, No. 9, 911–913 (2009), doi: https://doi.org/10.1111/j.1460-9592.2009.03085.x.

    Article  PubMed  Google Scholar 

  31. F. Graus, M. J. Titulaer, R. Balu, and J. Dalmau, “A clinical approach to diagnosis of autoimmune encephalitis,” Lancet Neurol., (2016), doi: https://doi.org/10.1016/S1474-4422(15)00401-9.

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Authors and Affiliations

  1. Russian Postgraduate Medical Academy, Moscow, Russia

    E. E. Vasenina, O. S. Levin, O. A. Gan’kina & A. Sh. Chimagomedova

  2. Botkin City Clinical Hospital, Moscow, Russia

    D. I. Levikov

Authors
  1. E. E. Vasenina
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  2. O. S. Levin
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  3. O. A. Gan’kina
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  4. A. Sh. Chimagomedova
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  5. D. I. Levikov
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Correspondence to E. E. Vasenina.

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Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 117, No. 2, Iss. 1, pp. 110–116, February, 2017.

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Vasenina, E.E., Levin, O.S., Gan’kina, O.A. et al. Autoimmune Anti-NMDA Receptor Encephalitis. Neurosci Behav Physi 48, 650–656 (2018). https://doi.org/10.1007/s11055-018-0612-6

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