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Anti-NMDA-R encephalitis: Follow-up of 24 months

Encefalite anti-NMDA-R: seguimento de 24 meses

ABSTRACT

Anti-N-methyl-D-aspartate receptor (anti-NMDA-R) encephalitis is the second-most-common cause of autoimmune encephalitis, based on epidemiological studies. It has been predominantly described in young females, with prominent psychiatric symptoms, memory loss, decrease in level of consciousness, epilepsy, and central hypoventilation. The condition is commonly associated with mature ovarian teratomas. We describe a video report with a classic presentation of anti-NMDA-R encephalitis in a young patient with no identifiable tumor. Anti-NMDA encephalitis is a recognizable and treatable illness. The prognosis of patients depends on early diagnosis, implementation of appropriate immunomodulatory therapy and, in paraneoplastic cases, complete tumor removal. Clinicians should be wary of this condition, especially when assessing patients with recent onset of psychiatric symptoms unresponsive to antipsychotic treatment.

Key words:
Anti-NMDA-R; autoimmune encephalitis; psychiatric symptoms.

RESUMO

A encefalite anti-NMDA é a segunda causa mais comum de encefalite autoimune, com base em estudos epidemiológicos. Foi descrito predominantemente em mulheres jovens, com sintomas psiquiátricos proeminentes, perda de memória , diminuíção do nível de consciência, epilepsia e hipoventilação central. É comumente associada a teratomas ovarianos maduros. Descrevemos uma paciente jovem, com a apresentação clássica da encefalite anti-NMDA, sem tumor identificável. A encefalite anti-NMDA é uma doença tratável e reconhecível. O prognóstico dos pacientes depende do diagnóstico precoce, da implementação da terapia imunomoduladora apropriada e, no caso de paraneoplasia, a remoção completa do tumor. Esta condição deve ser lembrada, especialmente quando Tratam-se de pacientes com início recente de sintomas psiquiátricos que não respondem ao tratamento antipsicótico.

Palavras-chave:
Anti-NMDA-R; encefalite autoimune; sintomas psiquiátricos.

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REFERENCES

  • Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the eff ects of antibodies.Lancet Neurol 2008;7:1091-1098.
  • Gregory S. Day, Sasha M. High, Bianca Cot, David F. Tang-Wai. Anti-NMDA-Receptor Encephalitis: Case Report and Literature Review of an Under-Recognized Condition. J Gen Intern Med 26:811-816.
  • Vitaliani R, Mason W, Ances B, et al. Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol 2005;58:594-604.
  • 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 Neurol2013;12: 157-165.
  • Dalmau J, Tuzun E, Wu HY, et al. Paraneoplastic anti-N-methyl-Daspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol2007;61:25-36.
  • Iizuka T, Sakai F, Ide T, et al. Anti-NMDA receptor encephalitis in Japan: Long-term outcome without tumor removal. Neurology 2008;70: 504-511.
  • Wandinger KP, Saschenbrecker S, Stoecker W, Dalmau J. Anti-NMDA-receptor encephalitis: A severe, multistage, treatable disorder presenting with psychosis.J Neuroimmunol 2011;231:86-91.
  • Florance NR, Davis RL, Lam C, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol2009;66:11-18
  • Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the eff ects of antibodies. Lancet Neurol2008; 7:1091-1098.
  • Hughes EG, Peng X, Gleichman AJ, et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci 2010;30:5866- 5875.
  • Gable MS, Gavali S, Radner A, et al. Anti-NMDA receptor encephalitis: report of ten cases and comparison with viral encephalitis. Eur J Clin Microbiol Infect Dis 2009;28:1421-1429.
  • Tsutsui K, Kanbayashi T, Tanaka K, et al. Anti-NMDA-receptor antibody detected in encephalitis, schizophrenia, and narcolepsy with psychotic features BMC Psychiatry 2012;12:37.

Publication Dates

  • Publication in this collection
    Jul-Sep 2013

History

  • Received
    07 May 2013
  • Accepted
    15 July 2013
Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br