Overlapping anti-NMDAR encephalitis and multiple sclerosis: A case report and literature review

Liu, Pan; Yan, Hui; Li, Haizhe; Zhang, Chunhua; Li, Yanfang

doi:10.3389/fimmu.2023.1088801

Cited by 9 publications

(8 citation statements)

References 28 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Keyword clustering mapping showed that studies in the field of anti-NMDA encephalitis were mainly centered on its definition, pathogenesis, clinical manifestations, diagnostic indicators, therapeutic modalities, and case reports, and the results confirmed that anti-NMDA encephalitis is an autoimmune-mediated disease manifesting as a complex neuropsychiatric syndrome, which results in a wide range of neurological symptoms, including psychiatric symptoms, movement disorders, memory disorders ( 14 ). And according to the clustering results, for cluster 2 we explored the specific clinical manifestations of anti-NMDA encephalitis, suggesting that patients with anti-NMDA receptor encephalitis present a characteristic stage-by-stage clinical course, and according to the course curve of classical anti-NMDAR encephalitis drawn by Kayser and Dalmau ( 32 ), we found that patients often have an antecedent infection 2 weeks before the onset of the disease, which leads to the development of certain antecedent symptoms, mainly viral cold symptoms; 1–2 weeks of progression of psychiatric symptoms, such as hallucinations, mania, delusions, anxiety, insomnia; weeks to months of neurological complications: disorders of consciousness, central hypoventilation, and even coma, often accompanied by dyskinesia and seizures; and months to years of neurological symptoms: executive functions, hypoparathyroidism and hyperventilation.…”

Section: Discussionmentioning

confidence: 82%

“…Anti- N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune-mediated disease characterized by a complex neuropsychiatric syndrome, and an antibody to cerebrospinal fluid (CSF) targeting the GluN1 subunit of NMDAR exists ( 14 , 15 ), a brain parenchymal inflammation associated with autoimmune-related neurologic dysfunction ( 16 ). Anti-NMDA receptor encephalitis was first reported in 2005, when symptoms of psychotic features, memory loss, and altered consciousness were found in four young women with ovarian teratomas ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Global study of anti-NMDA encephalitis: a bibliometric analysis from 2005 to 2023

Song,

Luo,

Huang

et al. 2024

Front. Neurol.

View full text Add to dashboard Cite

BackgroundAutoimmune diseases have always been one of the difficult diseases of clinical concern. Because of the diversity and complexity of its causative factors, unclear occurrence and development process and difficult treatment, it has become a key disease for researchers to study. And the disease explored in this paper, anti-NMDA encephalitis, belongs to a common type of autoimmune encephalitis. However, the quality of articles and research hotspots in this field are not yet known. Therefore, in this field, we completed a bibliometric and visualization analysis from 2005 to 2023 in order to understand the research hotspots and directions of development in this field.Materials and methodsWe searched the SCI-expanded databases using Web of Science’s core databases on January 22, 2024 and used tools such as VOS viewer, Cite Space, and R software to visualize and analyze the authors, countries, journals, institutions, and keywords of the articles.ResultsA total of 1,161 literatures were retrieved and analyzed in this study. China was the country with the most total publications, and USA and Spain were the most influential countries in the field of anti-NMDA encephalitis. University of Pennsylvania from USA was the institution with the highest number of publications. While Dalmau Josep is the most prolific, influential and contributing author who published one of the most cited articles in Lancet Neurology, which laid the foundation for anti-NMDA encephalitis research, the top three appearances of keyword analysis were: “antibodies”, “diagnosis”, and “autoimmune encephalitis.”ConclusionBibliometric analysis shows that the number of studies on anti-NMDA encephalitis is generally increasing year by year, and it is a hot disease pursued by researchers. USA and Spain are leading in the field of anti-NMDA encephalitis, while China should continue to improve the quality of its own research. The suspected causes of anti-NMDA encephalitis other than ovarian teratoma and herpes simplex, the specific clinical manifestations that are not masked by psychiatric symptoms, the diagnostic modalities that are faster and more accurate than antibody tests, and the improvement of treatment modalities by evaluating prognosis of various types of patients are the hotspots for future research.

show abstract

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Global study of anti-NMDA encephalitis: a bibliometric analysis from 2005 to 2023

Song,

Luo,

Huang

et al. 2024

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…Focal abnormalities were found in three patients while extreme delta brush was only observed in one patient. [6] .…”

Section: Discussionmentioning

confidence: 99%

“…In patients with overlapping MS, the average age of onset is slightly higher (31) and our patient’s age deviates even more significantly from the typically younger patient population. [6] , [25] , [26] In some cases, anti-NMDAR encephalitis occurs before MS, while in the majority of cases, the encephalitis occurs during the course or even a relapse of MS, suggesting a potential triggering effect of MS on anti-NMDAR encephalitis. [22] This might be due to demyelination exposing neuronal antigens, which in turn trigger an intrathecal immune response.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anti-NMDA receptor encephalitis in a 73-year-old female with secondary progressive multiple sclerosis: A case report

Kachlmeier

Adams

Zahalka

2023

Epilepsy & Behavior Reports

View full text Add to dashboard Cite

Glucocorticoid-dependent multiple sclerosis overlapping anti-NMDA receptor encephalitis: a case report and literature review update

Yang,

2023

Neurol Sci

View full text Add to dashboard Cite

Background Previous studies suggest a relationship between central nervous system inflammatory demyelinating diseases and anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. Also, the overlap between anti-NMDAR encephalitis and multiple sclerosis (MS) has been reported. However, the pathogenesis and clinical characteristics are still obscure. Case presentation A 33-year-old woman presented with diplopia and sensory ataxia at the onset. The cerebrospinal fluid (CSF) anti-NMDAR antibodies were positive (1:3.2), and nuclear magnetic resonance imaging (MRI) showed bilateral centrum ovale and lateral ventricle demyelinating lesions. Therefore, she was diagnosed with anti-NMDAR encephalitis. After administering intravenous immunoglobulin and oral prednisone, her lesions disappeared, and symptoms were relieved. The condition was maintained with a low dose of prednisone, but her lesions reappeared on MRI. Consequently, immunomodulatory therapy of mycophenolate mofetil was initiated. However, she developed dysarthria and right limb ataxia after 10 months with a positive CSF anti-NMDAR antibody (1:1) and positive oligoclonal band. The MRI showed symmetrical multiple demyelinating lesions. Considering the MS diagnosis, her neurological dysfunction again improved significantly after intravenous methylprednisolone. Unfortunately, her symptoms aggravated for the second time when teriflunomide was started. Finally, her condition was controlled again with oral prednisone. Conclusions Consistent with previous cases of overlapping anti-NMDAR encephalitis and MS, patients often show atypical symptoms on MRIs and immunological tests. The overlap cannot be arbitrarily treated because of the recurrence of previous diseases. Long-term follow-up, dynamic antibody monitoring, and MRI examination are crucial for these patients. The special dependency of the patient on glucocorticoids in this study has been rarely reported, which may guide the treatment of insensitivity to disease-modifying therapy in recurrent overlapping anti-NMDAR encephalitis and MS.

show abstract

Overlapping anti-NMDAR encephalitis and multiple sclerosis: A case report and literature review

Cited by 9 publications

References 28 publications

Global study of anti-NMDA encephalitis: a bibliometric analysis from 2005 to 2023

Global study of anti-NMDA encephalitis: a bibliometric analysis from 2005 to 2023

Anti-NMDA receptor encephalitis in a 73-year-old female with secondary progressive multiple sclerosis: A case report

Glucocorticoid-dependent multiple sclerosis overlapping anti-NMDA receptor encephalitis: a case report and literature review update

Contact Info

Product

Resources

About