Antecedent anti-NMDA receptor encephalitis in two patients with multiple sclerosis

Baheerathan, Aravindhan; Brownlee, Wallace; Chard, Declan; Shields, Kevin; Gregory, Ralph; Trip, S Anand

doi:10.1016/j.msard.2016.12.009

Cited by 19 publications

(10 citation statements)

References 8 publications

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“…The average age was 31.3 years. The first case was reported from Japan ( 7 ), along with two from Germany ( 8 , 9 ), three from England ( 6 , 10 ) and one from Turkey ( 11 ). Our patient was the first case from China.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Overlapping Multiple Sclerosis With Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report and Review of Literature

et al. 2020

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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder mediated by NMDAR antibodies, typically manifesting as behavioral complaints, psychosis, seizures, movement disorders, hypoventilation, and autonomic dysfunction. In recent years, the predisposing factors and pathophysiological mechanisms of anti-NMDAR encephalitis have been tried to be clarified. It has been recognized that an overlap may be observed between anti-NMDAR encephalitis and inflammatory demyelinating disease. However, anti-NMDAR encephalitis is rarely associated with multiple sclerosis. Here, we describe a Chinese female patient diagnosed with relapsing remitting multiple sclerosis who developed anti-NMDAR encephalitis. Further, we discuss the previously reported literature.

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Section: Discussionmentioning

confidence: 99%

Case Report: Overlapping Multiple Sclerosis With Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report and Review of Literature

et al. 2020

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“…[26][27][28] The MS diseasemodifying therapy (DMT; interferon-β and glatiramer acetate) can be commenced when the patient develops a second clinical or radiological demyelinating episode or fulfills MS diagnosis according to the 2010 revised McDonald criteria 29 and in the patients with high risk of conversion to MS, such as positive intrathecal IgG synthesis and central nervous system (CNS) oligoclonal bands or multiple other typical asymptomatic demyelinating lesions. 30 The coexistence or sequential presentation of anti-NMDAR encephalitis and demyelinating disorders, such as NMOSDs, 14,31-34 ADEM, 35,36 myelitis, 37,38 or MS, 15,39 has been reported. Titulaer et al 14 reported 23 patients with overlapping demyelinating syndromes and anti-NMDAR encephalitis.…”

Section: Discussionmentioning

confidence: 99%

“…Anti-NMDAR encephalitis was also reported in two female and one male patients with subsequent NMOSDs, in which two cases had the anti-AQP4 antibody. [31][32][33] Baheerathan et al 39 reported two cases of anti-NMDAR encephalitis who had subsequently developed double vision, facial weakness, and cerebellar ataxia in the first case and sensory symptoms in the lower limbs and trunk in the other. In these two cases, brain and spine MRIs and CSF studies fulfilled diagnostic criteria for MS (McDonald 2010 criteria).…”

Section: Discussionmentioning

confidence: 99%

Pediatric Relapsing Anti-NMDAR Encephalitis Crossing with Tumefactive Demyelinating Lesion

2018

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Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune encephalopathy characterized by neuropsychiatric symptoms, autonomic instability, and abnormal movements. Most children who undergo tumor removal and receive appropriate immunosuppressants have substantial neurological improvement. We report a 14-year-old girl with relapsing anti-NMDAR encephalitis who presented with paroxysmal tingling and weakness of the right lower limb. Despite long-term prophylaxis with immunotherapy (azathioprine), tumefactive demyelinating lesion and multifocal subcortical white matter lesions were identified on magnetic resonance imaging, which improved after high doses of steroid therapy. There may be overlap between the clinical manifestations of anti-NMDAR encephalitis and acquired demyelination syndromes in children.

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“…Since the criterion of dissemination in space for diagnosing MS isn't fulfilled and given the absence of any history or clinical signs of MS before the onset of encephalitis, pre-existing MS and now superimposed NMDAR-E seems to be unlikely. Longitudinal reevaluation in this regard however is important, since there are rare case reports of co-existent MS and NMDAR-E [20,21]. Of note, the unremarkable evoked potentials were performed after having administered 2 cycles of plasma exchange, at a time when the patients' symptoms already had remitted.…”

Section: Discussionmentioning

confidence: 99%

Anti-NMDA receptor encephalitis and overlapping demyelinating disorder in a 20-year old female with borderline personality disorder: proposal of a diagnostic and therapeutic algorithm for autoimmune encephalitis in psychiatric patients “case report”

et al. 2021

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Background Anti-NMDA receptor encephalitis (NMDAR-E) is an autoimmune encephalitis (AE) mainly affecting young females. It typically presents with isolated psychiatric symptoms (e.g. depressed mood) at first and neurological abnormalities (e.g. seizures, movement disorders) only develop later. Thus, there is a high risk of overlooking NMDAR-E in patients with preexisting psychiatric illness due to symptom overlap in the prodromal period of the disease when treatment is most effective. Although rare, concomitant or sequential development of a demyelinating disorder is increasingly recognized as an associated disease entity (overlap syndrome), with immediate diagnostic and therapeutic implications. Case presentation We report a patient with a borderline personality disorder (BPD), which developed NMDAR-E and an overlapping demyelinating disorder with anti-Myelin oligodendrocyte glycoprotein (MOG) -IgG positivity. The initial clinical presentation with predominantly affective symptoms (e.g. mood lability, anxiety, depressed mood) lead us to suspect an exacerbation of the BPD at first. However, acute changes in premorbid behavior, newly developed psychotic symptoms and memory deficits lead us to the correct diagnosis of an AE, which was further complicated by the development of a demyelinating disorder. As a result of impaired illness awareness and psychosis, diagnostic and treatment was difficult to carry out. The symptoms completely remitted after treatment with methylprednisolone 1 g daily for 5 days and 5 cycles of plasma exchange. Conclusions Continuous awareness for neuropsychiatric clinical warning signs in patients with a pre-diagnosed psychiatric disorder is important for a timely diagnosis. Therefore, we believe that the diagnostic and therapeutic algorithm provided here, for the first time specifically addressing patients with preexisting psychiatric illness and integrating overlap syndromes, can be a useful tool. Moreover, in order to timely perform diagnostics and treatment, judicial approval should be obtained rapidly.

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Antecedent anti-NMDA receptor encephalitis in two patients with multiple sclerosis

Cited by 19 publications

References 8 publications

Case Report: Overlapping Multiple Sclerosis With Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report and Review of Literature

Case Report: Overlapping Multiple Sclerosis With Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report and Review of Literature

Pediatric Relapsing Anti-NMDAR Encephalitis Crossing with Tumefactive Demyelinating Lesion

Anti-NMDA receptor encephalitis and overlapping demyelinating disorder in a 20-year old female with borderline personality disorder: proposal of a diagnostic and therapeutic algorithm for autoimmune encephalitis in psychiatric patients “case report”

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