Diversity in anti‐N‐methyl‐D‐aspartate receptor encephalitis: Case‐based evidence

Pinho, João; Rocha, João Carlos da; Rodrigues, Margarida; Pereira, João; Maré, Ricardo; Ferreira, Carla; Lourenço, Esmeralda; Beleza, Pedro

doi:10.1111/j.1440-1819.2011.02308.x

Cited by 9 publications

(5 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given this previous review of NMDA‐R antibodies, we will not discuss these further in our study. Psychosis is a common feature of the encephalitis syndromes that are classically associated with these antibodies – often as an early feature before the development of other features of encephalitis, such as seizures, movement disorders, autonomic instability, and impaired consciousness . The importance of these antibodies is clear when psychosis presents in the context of encephalitis, but the challenge in psychiatry is to determine their relevance in clinically uncomplicated psychosis.…”

Section: Vgkc‐complex Antibodiesmentioning

confidence: 99%

Autoantibodies against voltage‐gated potassium channel and glutamic acid decarboxylase in psychosis: A systematic review, meta‐analysis, and case series

Grain

Lally

Stubbs

et al. 2017

Psychiatry Clin Neurosci

View full text Add to dashboard Cite

Antibodies to the voltage-gated potassium channel (VGKC) complex and glutamic acid decarboxylase (GAD) have been reported in some cases of psychosis. We conducted the first systematic review and meta-analysis to investigate their prevalence in people with psychosis and report a case series of VGKC-complex antibodies in refractory psychosis. Only five studies presenting prevalence rates of VGKC seropositivity in psychosis were identified, in addition to our case series, with an overall prevalence of 1.5% (25/1720) compared to 0.7% in healthy controls (12/1753). Meta-analysis established that the pooled prevalence of GAD65 autoantibodies was 5.8% (95% confidence interval [CI]: 2.0-15.6%; I = 91%; nine studies) in psychotic disorders, with a prevalence of 4.6% (95%CI: 1.2-15.9%; nine studies; I = 89%) and 6.2% (95%CI: 1.2-27.0%; two studies; I = 69%) in schizophrenia and bipolar disorder, respectively. People with psychosis were more likely to have GAD65 antibodies than controls (odds ratio [OR], 2.24; 95%CI: 1.28-3.92%; P = 0.005; eight studies; I = 0%). Among 21 participants with treatment-resistant psychosis, none had VGKC antibodies. The prevalence of VGKC antibodies is low in psychosis. Our preliminary meta-analysis suggests that GAD autoantibodies are more common in people with psychosis than in controls, although few studies accounted for the possibility of co-existing type 1 diabetes mellitus and the clinical significance of reported GAD titers remains unclear. The paucity of studies reporting thresholds for defining GAD abnormality and rates of comorbid type 1 diabetes mellitus precludes interpretations regarding the influence of GAD antibodies on the development of psychotic disorders and may have led to an overestimate of the prevalence of GAD. Our case series fails to support the hypothesis that VGKC antibodies are linked to treatment resistance in psychosis, but the literature to date is remarkably sparse.

show abstract

Section: Vgkc‐complex Antibodiesmentioning

confidence: 99%

Autoantibodies against voltage‐gated potassium channel and glutamic acid decarboxylase in psychosis: A systematic review, meta‐analysis, and case series

Grain

Lally

Stubbs

et al. 2017

Psychiatry Clin Neurosci

View full text Add to dashboard Cite

show abstract

“…Main area of brain involvement is limbic system, so that pyramidal tract involvement and residual motor deficits are less common. 7 In our series, only one child had pyramidal involvement.…”

Section: Discussionmentioning

confidence: 52%

“…Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a diffuse central nervous system disease process characterised by dysfunction of subcortical structures, limbic regions, amygdalae, and frontostriatal circuitry. 6,7 Clinically, it has a gradual progression and good recovery. Main area of brain involvement is limbic system, so that pyramidal tract involvement and residual motor deficits are less common.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Profile of Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Children

Nair¹,

Parameswaran²

2016

jemds

View full text Add to dashboard Cite

BACKGROUNDEncephalitis in children is associated with high rate of morbidity and mortality. Many sporadic cases of encephalitis in children have recently been found to be CSF negative for infective markers. Antibodies against neuronal proteins in CSF are being detected more frequently in such patients and are well responsive to immunotherapy, if timely diagnosed. Anti-N-Methyl-D-Aspartate receptor (anti-NMDA) antibody mediated encephalitis is the most common in children among this group.The objective of this study was to determine the incidence and clinical profile of anti-NMDA antibody mediated encephalitis in children and its early (6-8 weeks) and late (1 year) treatment responses. MATERIALS AND METHODSIt was a descriptive study done in a tertiary care teaching hospital in south India. All children, 3 months to 12 years, presenting as acute encephalopathy, from January 2012 to December 2014 were evaluated and those with CSF anti-NMDA antibody positive children were treated with standard protocol and followed up at 6 weeks, 8 weeks and one year. RESULTSWe had 178 children presented as acute encephalitis during the 3-year period. 18 (10%) children were positive for anti NMDA antibody in CSF. Female gender predominated by 89%. Predominant clinical features were in the descending order, behaviour and psychiatric 89%, speech dysfunction 72 %, movement disorders 56%, seizures 22% and autonomic phenomena 6%. Majority (78%) responded completely to immunotherapy. CONCLUSIONAnti-NMDA receptor encephalitis is not rare in children. In children presenting as acute encephalitis with predominant neuropsychiatric symptoms or if CSF negative for infection, NMDA antibody test in CSF is a must. Prompt diagnosis is important because it is amenable to immunotherapy and longterm prognosis is very good.

show abstract

“…Although initially monosymptomatic, the majority of patients will exhibit symptoms in at least 4 categories within 4 weeks after presentation, with monosymptomatic disease occurring in only 5% of individuals [56]. The initial clinical presentation differs among age groups: while adults tend to manifest behavioral changes, movement disorders and seizures are more common in children, although psychopathological manifestations can also dominate the clinical picture [29,[58][59][60][61], as well as developmental regression [13]. In older adults (>45 years) predominant symptoms also diverge, as these patients are more prone to exhibit behavioral changes, and cognitive impairment, and less commonly movement disorders, decreased level of consciousness, or prodromal symptoms [57].…”

Section: Anti-nmdarmentioning

confidence: 99%

Neuropsychiatric symptoms in autoimmune encephalopathies: a clinician’s guide

Carvalho¹,

Massano²,

Coelho³

2014

IJCNMH

View full text Add to dashboard Cite

Background: The spectrum of central nervous system autoimmune disorders has recently expanded with the discovery of disorders associated with antibodies directed against the neuronal membrane surface. Although many of these disorders have an underlying malignancy and present with signs of dysfunction of the limbic system (paraneoplastic limbic encephalitis, PLE), a high proportion of cases is non-paraneoplastic. They may occur with milder symptoms, and present no abnormalities in the exams usually used in the investigation of PLE. A striking number of cases may be misdiagnosed as primary psychiatric or other neurological disorders. This paper aims to review the current knowledge on this topic, and provide physicians with an updated text on the neuropsychiatric presentation, diagnostic approach and current management of autoimmune encephalopathies.

show abstract

Diversity in anti‐N‐methyl‐D‐aspartate receptor encephalitis: Case‐based evidence

Cited by 9 publications

References 15 publications

Autoantibodies against voltage‐gated potassium channel and glutamic acid decarboxylase in psychosis: A systematic review, meta‐analysis, and case series

Autoantibodies against voltage‐gated potassium channel and glutamic acid decarboxylase in psychosis: A systematic review, meta‐analysis, and case series

Incidence and Clinical Profile of Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Children

Neuropsychiatric symptoms in autoimmune encephalopathies: a clinician’s guide

Contact Info

Product

Resources

About