Anti-NMDA receptor encephalitis with associated catatonia during pregnancy

McCarthy, Ailbhe; Dineen, Jennifer; McKenna, Peter J.; Keogan, M.; Sheehan, John; Lynch, Timothy; O’Rourke, Killian

doi:10.1007/s00415-012-6561-z

Cited by 47 publications

(34 citation statements)

References 10 publications

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“…Pathological examination of tissue sections positive for anti‐NMDA‐R encephalitis highlight the role of teratomas in this disease. According to the case series to date, four of the 12 cases had ovarian teratoma, and the tumors were always explored by MRI 3 weeks to 4 months after the appearance of neurological symptoms (Table ) . Negative results are related to barrier of the gravid uterus, short follow‐up time, or poor auxiliary examination.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, involvement of NMDA‐R may affect brain development, and glutamatergic dysfunction may play an important role in the genesis of schizophrenia . Early immunomodulatory therapy may hasten recovery . Treatment with corticosteroids, intravenous immunoglobulin (IVIg), plasmapheresis, and removal of a teratoma resulted in favorable outcomes .…”

Section: Discussionmentioning

confidence: 99%

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Anti‐NMDA‐receptor encephalitis during pregnancy: A case report and literature review

Xiao

Gui

Bai

et al. 2017

J of Obstet and Gynaecol

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Anti-N-methyl-d-aspartate receptor (anti-NMDA-R) encephalitis is an autoimmune disorder that was first described by Dr Vitaliani in 2005. In 2007, Dalmau et al. found anti-NMDA-R antibody expressed both in the hippocampus and prefrontal nerve cell membrane, finally proposing the diagnosis of autoimmune anti-NMDA-R encephalitis. Most of the patients are female (91%), with ages ranging from 4 to 76 years. The average age is 23 years, a birth peak age, although anti-NMDA-R encephalitis is rare during pregnancy. The disorder is characterized by prominent psychosis, dyskinesias, seizures, autonomic disturbance, and central hypoventilation. We report a 24-year-old woman hospitalized at 28 gestational weeks with acute-onset psychosis. Over the course of 3 weeks, her mental status worsened until she fell into a coma. Both serum and cerebrospinal fluid anti-NMDA-R antibodies were found to be positive. At cesarean section, a healthy baby boy was born and a wedge-shaped bilateral ovarian resection was performed. Treatment with corticosteroids, intravenous immunoglobulin, and plasmapheresis can lead to improved outcomes for both mother and baby.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anti‐NMDA‐receptor encephalitis during pregnancy: A case report and literature review

Xiao

Gui

Bai

et al. 2017

J of Obstet and Gynaecol

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“…7,103 The association NMDAR encephalitis with catatonia seems to be even stronger than the association with psychosis. 72 Where catatonia is reported, it is often malignant catatonia and tends to cooccur with psychosis 104 and mania. 105 NMDAR encephalitis is strongly linked to neuroleptic malignant syndrome, with one study suggesting as many as 21 out of 36 (58%) patients with NMDAR antibody encephalitis who were administered antipsychotics developed suspected neuro leptic malignant syndrome.…”

Section: Autoimmune Disorders Directed At Cns Targets Causing Catatoniamentioning

confidence: 99%

Catatonia and the immune system: a review

Rogers

Pollak

Blackman

et al. 2019

The Lancet Psychiatry

147

119

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Catatonia is a psychomotor disorder featuring stupor, posturing, and echophenomena. This Series paper examines the evidence for immune dysregulation in catatonia. Activation of the innate immune system is associated with mutism, withdrawal, and psychomotor retardation, which constitute the neurovegetative features of catatonia. Evidence is sparse and conflicting for acute-phase activation in catatonia, and whether this feature is secondary to immobility is unclear. Various viral, bacterial, and parasitic infections have been associated with catatonia, but it is primarily linked to CNS infections. The most common cause of autoimmune catatonia is N-methyl-D-aspartate receptor (NMDAR) encephalitis, which can account for the full spectrum of catatonic features. Autoimmunity appears to cause catatonia less by systemic inflammation than by the downstream effects of specific actions on extracellular antigens. The specific association with NMDAR encephalitis supports a hypothesis of glutamatergic hypofunction in catatonia.

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“…Other options such as intravenous immunoglobulin, rituximab and cyclophosphamide were considered for the patient; however, the use was deferred secondary to lack of safety data in pregnant patients. After much discussion with the family, and from our institutional experience and evidence gleaned in the literature,3 4 we decided to treat the patient with plasmapheresis after approximately 1 month of hospitalisation. The patient received a total of seven plasma exchange treatments, given every 2 days over 14 days with one plasma volume exchange per treatment.…”

Section: Treatmentmentioning

confidence: 99%

Steroid unresponsive anti-NMDA receptor encephalitis during pregnancy successfully treated with plasmapheresis

Shahani

2015

BMJ Case Reports

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SUMMARYAnti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune disorder resulting in neurological and psychiatric symptoms. It is rare during pregnancy and treatment is extremely challenging as little data exist to guide management. A 26-year-old woman presented at 22 weeks of gestation with intermittent headache and an acute episode of bizarre behaviour and grandiose delusions resulting in hospitalisation. The patient was worked up for encephalitis and was found to have anti-NMDA receptor antibody in cerebrospinal fluid as well as in serum. She was initially treated with high-dose steroids but failed to improve clinically and serologically. She was then treated with plasmapheresis and showed clinical and serological response. She had a successful delivery at 37 weeks and the baby did not show serological evidence of disease. This case adds to the sparse literature of anti-NMDA receptor encephalitis during pregnancy and adds to the differential diagnosis of new onset psychiatric symptoms during pregnancy. BACKGROUND

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Anti-NMDA receptor encephalitis with associated catatonia during pregnancy

Cited by 47 publications

References 10 publications

Anti‐NMDA‐receptor encephalitis during pregnancy: A case report and literature review

Anti‐NMDA‐receptor encephalitis during pregnancy: A case report and literature review

Catatonia and the immune system: a review

Steroid unresponsive anti-NMDA receptor encephalitis during pregnancy successfully treated with plasmapheresis

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