Little Children, Bigger Problems: Anti-N-Methyl D-Aspartate Receptor Encephalitis!

  • Ashwini Prithvi
  • Shivan Kesavan
  • Arushi Gahlot SainiEmail author
  • Renu Suthar
  • Anita Mahadevan
Clinical Brief


Anti N-methyl D-aspartate receptor (NMDAR) antibody positive autoimmune encephalitis is a well-described entity both in adults as well as in children. The authors report an 18-mo-old boy who presented with seizures, movement disorder, cognitive impairment, and behavioral disturbances. Anti-NMDAR encephalitis was confirmed by detection of NMDAR antibodies in the cerebrospinal fluid. The patient was administered pulse corticosteroids and intravenous immunoglobulin followed by further immunomodulatory therapy. No tumor was detected on screening. The child remained unresponsive to treatment. The authors wish to highlight the occurrence of anti-NMDAR encephalitis in young toddlers and the poor response to therapy often seen in very young children.


Anti-N-methyl D-aspartate NMDAR Autoimmune encephalitis Infant Encephalitis 



The authors would like to acknowledge Dr. Naveen Sankhyan and Dr. S. Bhanudeep for their help in patient management.

Authors’ Contribution

AP, SK: Original draft of the manuscript; AGS, RS: Final revision of the manuscript; AM: Analysis of the antibody profile and approval of final version of the manuscript. Dr. Naveen Sankhyan, Head, Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest



  1. 1.
    Granerod J, Ambrose HE, Davies NW, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010;10:835–44.CrossRefGoogle Scholar
  2. 2.
    Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013;12:157–65.CrossRefGoogle Scholar
  3. 3.
    Armangue T, Titulaer MJ, Málaga I, et al. Pediatric anti-NMDAR encephalitis- clinical analysis and novel findings in a series of 20 patients. J Pediatr. 2013;162:850–6.e2.CrossRefGoogle Scholar
  4. 4.
    Hilderink M, Titulaer MJ, Schreurs MWJ, Keizer K, Bunt JEH. Transient anti-NMDAR encephalitis in a newborn infant due to transplacental transmission. Neurol Neuroimmunol Neuroinflamm [Internet]. 2015 Jun 18. Available at: Accessed 13 Dec 2018.
  5. 5.
    Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011;10:63–74.CrossRefGoogle Scholar
  6. 6.
    Armangue T, Spatola M, Vlagea A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis. Lancet Neurol. 2018;17:760–72.CrossRefGoogle Scholar
  7. 7.
    Shin Y-W, Lee S-T, Park K-I, et al. Treatment strategies for autoimmune encephalitis. Therap Adv Neurol Disord. 2018;11:1–19.Google Scholar
  8. 8.
    Suppiej A, Nosadini M, Zuliani L, et al. Plasma exchange in pediatric anti-NMDAR encephalitis: a systematic review. Brain Dev. 2016;38:613–22.CrossRefGoogle Scholar
  9. 9.
    Zhang Y, Liu G, Jiang M, Chen W, Su Y. Efficacy of therapeutic plasma exchange in patients with severe refractory anti-NMDA receptor encephalitis. Neurotherapeutics. 2019.
  10. 10.
    Todoric K, Koontz JB, Mattox D, Tarrant TK. Autoimmunity in immunodeficiency. Curr Allergy Asthma Rep. 2013;13:361–70.CrossRefGoogle Scholar
  11. 11.
    Botto M, Walport MJ. C1q, autoimmunity and apoptosis. Immunobiology. 2002;205:395–406.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  • Ashwini Prithvi
    • 1
  • Shivan Kesavan
    • 1
  • Arushi Gahlot Saini
    • 1
    Email author
  • Renu Suthar
    • 1
  • Anita Mahadevan
    • 2
  1. 1.Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics CentrePost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Department of NeuropathologyNational Institute of Mental Health and NeurosciencesBangaloreIndia

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