Pediatric Anti-NMDA (N-methyl D-Aspartate) Receptor Encephalitis

Salvucci, Alana; Devine, Irisa M.; Hammond, David N.

doi:10.1016/j.pediatrneurol.2014.01.012

Cited by 35 publications

(29 citation statements)

References 12 publications

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“…The unilateral predominance of the abnormal movements observed in our patient has been previously reported in anti-NMDA receptor encephalitis, mainly in series of pediatric patients [5], [12], [13], [14], [23], [24], [25], [26], [27], [28], [29]. The unilateral predominance of the abnormal movements or seizures is a classical feature in other systemic antibody-mediated diseases including Rasmussen syndrome, systemic lupus erythematosus involving the central nervous system, Hashimoto encephalitis and Sydenham chorea, however the underlying pathophysiology of unilateral or bilateral asymmetric symptoms in autoimmune diseases remains poorly understood [12], [30], [31], [32], [33], [34].…”

Section: Discussionsupporting

confidence: 82%

Unilateral predominance of abnormal movements: A characteristic feature of the pediatric anti-NMDA receptor encephalitis?

Benjumea-Cuartas¹,

Eisermann²,

Simonnet³

et al. 2017

Epilepsy & Behavior Case Reports

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Anti-NMDA receptor encephalitis is a treatable autoimmune disease characterized by cognitive, motor and psychiatric features that primarily affects young adults and children. We present a case of a 7-year-old boy with asymmetrical (mainly right hemibody) and abnormal polymorphic movements without concomitant scalpictal EEG changes but had background slowing predominating over the left hemisphere. This report illustrates previous descriptions of asymmetric presentation of abnormal movements in pediatric anti-NMDA receptor encephalitis and emphasizes the importance of video-EEG interpreted within the overall clinical context, to differentiate epileptic from non-epileptic abnormal movements in patients with autoimmune encephalitis.

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Section: Discussionsupporting

confidence: 82%

Unilateral predominance of abnormal movements: A characteristic feature of the pediatric anti-NMDA receptor encephalitis?

Benjumea-Cuartas¹,

Eisermann²,

Simonnet³

et al. 2017

Epilepsy & Behavior Case Reports

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“…[20,22,23] Chorea, particularly dominant in children with anti-NMDAR encephalitis, typically occurs in patients with injury to the subthalamic nucleus, but it can also develop in patients with widespread cerebral injury. [4,24] In contrast, bradykinesia most likely occurred with injury to the substantia nigra or striatum, which may result in presynaptic or postsynaptic failure of dopaminergic transmission. [18,25] Therefore, dysfunction in basal ganglion-cortical loops due to anti-NMDAR antibodies might lead to different movement disorders in different patients.…”

Section: Discussionmentioning

confidence: 99%

Variations of movement disorders in anti-N-methyl-D-aspartate receptor encephalitis

et al. 2016

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Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is one of the most common autoimmune encephalitis that presents with a wide variety of movement disorders. The purpose of our study is to review the manifestations and duration of movement disorders in different ages with NMDAR encephalitis.A retrospective cohort of 28 patients (20 females and 8 males) with positive cerebrospinal fluid (CSF) anti-NMDAR antibody in a 5-year period from major hospitals in Taiwan was enrolled. They were categorized into 3 age groups: 7 patients were ≤10 years, 14 patients were 10 to 18 years, and 7 patients were >18 years.Total 28 patients (20 females and 8 males) with age ranging from 8 months to 38 years were enrolled. Nearly all patients (n = 27/28, 96%) presented with at least 2 types of disorders, including orofacial–lingual dyskinesia (OFLD; n = 20), catatonia (n = 19), tremor (n = 11), bradykinesia (n = 11), dystonia (n = 11), choreoathethosis (n = 9), and ballism (n = 3). Only 1 patient below 10 years presented with isolated periodic choreoathethosis without other movement disorders. OFLD was common in all age groups. Choreoathetosis was most common in patients aged ≤10 years, while catatonia was most common in patients aged >10 years (P = 0.001 and 0.020, respectively). Bradykinesia was also more common in patients aged >10 years (P = 0.020). The clinical presentations of movement disorders were not significantly different in the age of 10 to 18 years and those >18 years. Neither patient ≤10 years old nor male patients had associated tumors. All patients’ movement disorders were improved after treatment, while female patients with tumors had worse short-term outcome (P = 0.014). Compared with other disorders, choreoathetosis persisted significantly longer in patients ≤10 years (P = 0.038), while OFLD and catatonia last longer in patients >10 years (P = 0.047 and 0.002, respectively).Our study shows that hyperkinetic movements such as choreoathetosis are more common and last longer in younger age groups, whereas hypokinetic movements such as catatonia and bradykinesia are more common and last longer in older age groups. Female patients with ovarian tumors had worse short-term outcome.

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“…60 Children with predominantly psychiatric symptoms appear to benefit more from TPE, while those with a predominantly catatonic presentation benefit less. 62 TPE has also been used for treatment of relapses 63 and as second-line therapy for treatmentresistant disease 64 ASFA suggests five or six exchanges of 1-1.5 TPV, administered on alternate days to allow time for equilibration of antibody levels between cerebrospinal fluid and serum. 13 Early initiation of treatment is associated with better outcome.…”

Section: -4wks 13mentioning

confidence: 99%

Therapeutic plasma exchange in paediatric neurology: a critical review and proposed treatment algorithm

Eyre

Hacohen

Barton

et al. 2018

Develop Med Child Neuro

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Pediatric Anti-NMDA (N-methyl D-Aspartate) Receptor Encephalitis

Cited by 35 publications

References 12 publications

Unilateral predominance of abnormal movements: A characteristic feature of the pediatric anti-NMDA receptor encephalitis?

Unilateral predominance of abnormal movements: A characteristic feature of the pediatric anti-NMDA receptor encephalitis?

Variations of movement disorders in anti-N-methyl-D-aspartate receptor encephalitis

Therapeutic plasma exchange in paediatric neurology: a critical review and proposed treatment algorithm

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