Anti-NMDA receptor encephalitis in older adults: A systematic review of case reports

Giné-Serven, Eloi; Serra-Mestres, Jordi; Martínez-Ramírez, M.J.; Boix-Quintana, Ester; Davi-Loscos, Eva; Guanyabens, Nicolau; Casado, Virginia; Muriana, Desirée; Torres-Rivas, Cristina; Cuevas‐Esteban, Jorge; Labad, Javier

doi:10.1016/j.genhosppsych.2021.11.006

Cited by 9 publications

(10 citation statements)

References 42 publications

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“…However, an NMDARE is proven if just one of the clinical features is present and CSF immunoglobulin G (IgG) NMDAR N1 antibodies are detected, according to the Graus criteria [ 4 ]. The onset of NMDARE is often characterized by psychiatric symptoms [ 5 , 6 ]. Nevertheless, NMDAR autoantibodies are also detected in psychiatric patients who fail to fulfill NMDAR-encephalitis criteria [ [7] , [8] , [9] ].…”

Section: Nmdar Autoantibodies In Psychiatrymentioning

confidence: 99%

“…These authors suggested that the NMDAR autoantibodies play a role in a subgroup of psychotic patients [ 38 ]. A very recent investigation highlighted a specific psychopathology that may indicate an NMDARE, such as a polymorphic psychotic symptomatology, a fluctuating course with marked cognitive dysfunction and psychotic symptoms [ 39 ]. Thus, the psychopathology in relationship to the NMDAR-autoantibody status must be investigated in more depth in future studies.…”

Section: Nmdar Autoantibodies In Psychiatric Disordersmentioning

confidence: 99%

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NMDAR autoantibodies in psychiatric disease - An immunopsychiatric continuum and potential predisposition for disease pathogenesis

Hansen

2022

Journal of Translational Autoimmunity

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Section: Nmdar Autoantibodies In Psychiatrymentioning

confidence: 99%

Section: Nmdar Autoantibodies In Psychiatric Disordersmentioning

confidence: 99%

NMDAR autoantibodies in psychiatric disease - An immunopsychiatric continuum and potential predisposition for disease pathogenesis

Hansen

2022

Journal of Translational Autoimmunity

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“…Among the patients with anti- N-methyl-D-aspartate (NMDA) receptor encephalitis[ 59 - 62 ], one also tested positive for herpes simplex virus[ 59 ]. In this population, in this type of encephalitis, until 17.4% patients could present with catatonia[ 63 ]. The remaining case reports of catatonia in older patients involved a patient with paraneoplastic encephalitis[ 58 ] and a patient with anti-Hu encephalitis[ 61 ].…”

Section: Resultsmentioning

confidence: 99%

Catatonia in older adults: A systematic review

Jaimes-Albornoz¹,

Pellon-Santamaria²,

Nizama-Vía³

et al. 2022

WJP

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BACKGROUND Catatonia is a complex psychomotor syndrome that often goes unrecognized and untreated, even though its classification has evolved in recent years. Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications. The underrecognition of catatonia in older patients is also frequent, and research in this population is scarce. AIM To conduct a systematic review of the literature on catatonia in older people to ascertain its clinical characteristics across settings. METHODS Following the PRISMA guidelines, MEDLINE, EMBASE, and PsycINFO databases were searched from inception to December 2021, with a strategy aimed at identifying all articles published on catatonia in older adults. Titles and abstracts were scanned and selected independently by two authors. Papers investigating issues related to catatonia and/or catatonic symptoms in older people, with English abstracts available, were included. References of selected articles were revised to identify other relevant studies. RESULTS In total, 1355 articles were retrieved. After removing duplicates, 879 remained. Of the 879 identified abstracts, 669 were excluded because they did not meet the inclusion criteria. A total of 210 articles underwent full text review, and 51 were eliminated for various reasons. Fourteen more articles were selected from the references. Overall, 173 articles were reviewed: 108 case reports, 35 case series, 11 prospective cohort studies, 6 case-control studies, 3 retrospective cohort studies and 10 reviews. We found several particular aspects of catatonia in this population. Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. Older patients, compared to younger patients, have a higher risk of developing catatonia with benzodiazepine (BZD) withdrawal, in bipolar disorder, and in the general hospital. Age, together with other risk factors, was significantly associated with the incidence of deep venous thrombosis, neuroleptic malignant syndrome poor outcome, other complications and mortality. Treatment with BZDs and electroconvulsive therapy is safe and effective. Prompt treatment of its cause is essential to ensure a good prognosis. CONCLUSION Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. The risk of developing catatonia in some settings and conditions, as well as of developing complications, is high in this population. Symptomatic treatment is safe and effective, and timely etiologic treatment is fundamental.

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“…Autoimmune enteropathy is a rare complication of anti-NMDA encephalitis stemming from dysregulation of the immune system. The systematic review by Giné-Servén et al reports that 34.8% of adult patients with autoimmune encephalitis suffer from a motility disorder [ 4 ]. Yuan et al performed a retrospective observational study on 143 patients with anti-NMDA receptor encephalitis and found the most associated findings to be seizures, psychiatric complications, pulmonary infections, and GI disorders.…”

Section: Discussionmentioning

confidence: 99%

Anti-N-Methyl-D-Aspartate Receptor Encephalitis Complicated by Autoimmune Enteropathy and Pulmonary Embolism: A Rare Case

Haider¹,

Din²,

Dar³

et al. 2022

Cureus

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Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is an autoimmune disorder affecting the Nmethyl-D-aspartate receptors in the central and peripheral nervous systems. Gastrointestinal (GI) complications are rarely manifested in this disease. Autoimmune dysregulation of the GI tract is considered a potential cause. We present a challenging case of a 38-year-old male with a history of newly diagnosed epilepsy. He was admitted for three weeks of confusion, hallucinations, and bizarre behavior, and was later diagnosed with anti-NMDA encephalitis from a cerebrospinal fluid (CSF) immunological study. He was treated with a five days course of intravenous immunoglobulin (IVIG) and high-dose steroids. His course was further complicated with GI obstruction and upper GI bleed. His laboratory workup showed lactic acidosis and there was a concern for ischemic bowel injury. Computed tomography (CT) of the abdomen with contrast showed diffuse moderate to pronounced dilated small intestine swirling the mesenteric vessels, concerning for intestinal vascular compromise. The patient also became tachypneic and hypoxic, requiring 6 L of oxygen with a venti-mask. CT of the chest, abdomen, and pelvis with contrast revealed saddle pulmonary embolism (PE) extending to the right and left pulmonary arteries with right heart strain. He underwent emergent explorative laparotomy and emergent catheter-directed thrombectomy. Neither necrotic bowel nor any evidence of perforation or volvulus was noted during the laparotomy; however, the small bowel and the colon were reported to be significantly dilated, hyperemic, and engorged with blood without any evidence of ischemic bowel. He had a complicated 29-day admission course and recovered functional capacity to be safely discharged to a skilled nursing facility for further care. Physicians should keep in mind the gut-brain axis and autonomic effects on gut receptors of any patient presenting with psychosis and seizure disorder to provide timely care and improve morbidity and mortality in this patient population.

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Anti-NMDA receptor encephalitis in older adults: A systematic review of case reports

Cited by 9 publications

References 42 publications

NMDAR autoantibodies in psychiatric disease - An immunopsychiatric continuum and potential predisposition for disease pathogenesis

NMDAR autoantibodies in psychiatric disease - An immunopsychiatric continuum and potential predisposition for disease pathogenesis

Catatonia in older adults: A systematic review

Anti-N-Methyl-D-Aspartate Receptor Encephalitis Complicated by Autoimmune Enteropathy and Pulmonary Embolism: A Rare Case

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