The Spectrum of Movement Disorders in Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis Both in Children and Adults: An Experience From a Single Tertiary Care Center

Haq, Ayaz Ul; Nabi, Danish; Alam, Mehtab; Ullah, Samina A

doi:10.7759/cureus.20376

Cited by 5 publications

(8 citation statements)

References 31 publications

(46 reference statements)

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“…Results: (1) In our study there were 64 patients, of whom 76.6% (49/64) presented with MDs; the median age of onset in patients with MDs was 21 (15,35) years and 65.3% (32/49) were female. The three most common MDs were orofacial dyskinesia (OFLD) (67.3%), dystonia (55.1%), and stereotypies (34.7%).…”

mentioning

confidence: 70%

Analysis of characteristics of movement disorders in patients with anti-N-methyl-D-aspartate receptor encephalitis

Li,

Chen,

Zhou

et al. 2024

Front. Neurol.

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ObjectiveMovement disorders (MDs) are common in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis but are poorly studied. This study aimed to investigate the clinical characteristics of MDs and the clinical differences between patients with and without MDs in anti-NMDAR encephalitis.MethodsA retrospective study was conducted on patients with anti-NMDAR encephalitis who were first diagnosed and treated in the First People’s Hospital of Yunnan Province from January 2017 to September 2022. According to the presence or absence of MDs, all patients were divided into two groups, and the clinical manifestations, auxiliary examinations, and prognosis of the two groups were compared. Patients in the MDs group were further subgrouped by different ages (<12 years, 12–17 years, and ≥ 18 years) and genders, and the prevalence of each MD was compared in different age and gender groups.Results(1) In our study there were 64 patients, of whom 76.6% (49/64) presented with MDs; the median age of onset in patients with MDs was 21 (15,35) years and 65.3% (32/49) were female. The three most common MDs were orofacial dyskinesia (OFLD) (67.3%), dystonia (55.1%), and stereotypies (34.7%). Patients <12 years were more likely to experience chorea than patients in other age groups (p = 0.003). (2) Compared with the non-MDs group, patients in the MDs group showed higher rates of prodromal manifestations, autonomic dysfunction, consciousness disorders, as well as pulmonary infection and gastrointestinal dysfunction (all p < 0.05). Peripheral blood neutrophil to lymphocyte ratio (NLR) (p = 0.014), the proportion of cerebrospinal fluid (CSF) NMDAR antibody titers ≥1:32 (p = 0.047), ICU admission rate (p = 0.04), length of stay (p = 0.007), maximum mRS score in the course of disease (p = 0.001) and mRS score at discharge (p = 0.006) in the MDs group were significantly higher than the non-MDs group.ConclusionMDs associated with anti-NMDAR encephalitis were predominantly hyperkinetic. Chorea occurred more commonly in patients aged <12 years. Patients with MDs were prone to autonomic dysfunction, consciousness disorders, pulmonary infection, and gastrointestinal dysfunction; they had more intense inflammation, more severe disease, and a poorer short-term prognosis.

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confidence: 70%

Analysis of characteristics of movement disorders in patients with anti-N-methyl-D-aspartate receptor encephalitis

Li,

Chen,

Zhou

et al. 2024

Front. Neurol.

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“…9 So far three case series of anti NMDAR encephalitis patients have been published from Pakistan from the cities of Rawalpindi, Islamabad and Peshawar. [10][11][12] A comparison of demographics of our cases with those three publications is given in table 2.…”

Section: Discussionmentioning

confidence: 99%

“…cities of Rawalpindi, Islamabad and Peshawar. [10][11][12] A comparison of demographics of our cases with those three publications is given in table 2.…”

Section: Discussionmentioning

confidence: 99%

Experience with anti NMDA receptor antibody encephalitis in a tertiary care hospital in Pakistan

Rajput

Waqar

Hassan

et al. 2023

PJNS

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Background and objective: Anti NMDA receptor (Anti-NMDAR) antibody encephalitis is an increasingly recognized form of auto immune encephalitis. The objective of this study was to determine the demographic, clinical and laboratory factors associated with this syndrome. Methods: All cases presenting to neurology, Pakistan institute of medical sciences, Islamabad, from June 2017 till January 2020 were reviewed retrospectively. Patients fulfilling the diagnostic criteria for Anti NMDA receptor (Anti-NMDAR) antibody encephalitis were included. All patients were evaluated with cerebrospinal fluid (CSF)routine examination, MRI brain, autoimmune encephalitis profile and for presence of oligoclonal bands (OCB) in CSF. Statistical analysis was done using SPSS version 23.0. Results: A total of 7 patients were diagnosed as having Anti-NMDARantibody encephalitis. Five patients were female and two were male. Four patients had some type of psychiatric disturbances upon presentation of these behavioral abnormalities and irritability were found in all four. Orofacial abnormal movements were found in four patients while one patient had myoclonic seizures. Conclusion: Anti-NMDARreceptor encephalitis is a common cause of encephalitis associated with neurological and psychiatric symptoms. Delay in diagnosis can occur due to non-specific symptoms and signs present in early stages of illness,this can lead to long term neurological disability.

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“…35,36 Bradykinesia is uncommon but more often seen in older patients. 36 Overlap with catatonia and psychomotor agitation as well as side effects of antipsychotics can also complicate the picture.…”

Section: Autoimmune Encephalitismentioning

confidence: 99%

“…35 The phenomenology of abnormal movements is diverse and includes chorea, dystonia, myoclonus, tremor, and opisthotonic posturing. 35,36 Bradykinesia is uncommon but more often seen in older patients. 36 Overlap with catatonia and psychomotor agitation as well as side effects of antipsychotics can also complicate the picture.…”

Section: Autoimmune Encephalitismentioning

confidence: 99%

Diagnostic Uncertainties: Chorea

Cincotta

Walker

2023

Semin Neurol

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Chorea is a hyperkinetic movement disorder with a multitude of potential etiologies, both acquired and inherited. Although the differential diagnosis for new-onset chorea is extensive, there are often clues in the history, exam, and basic testing that can help to narrow the options. Evaluation for treatable or reversible causes should take priority, as rapid diagnosis can lead to more favorable outcomes. While Huntington's disease is most common genetic cause of chorea, multiple phenocopies also exist and should be considered if Huntington gene testing is negative. The decision of what additional genetic testing to pursue should be based on both clinical and epidemiological factors. The following review provides an overview of the many possible etiologies as well as a practical approach for a patient presenting with new-onset chorea.

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The Spectrum of Movement Disorders in Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis Both in Children and Adults: An Experience From a Single Tertiary Care Center

Cited by 5 publications

References 31 publications

Analysis of characteristics of movement disorders in patients with anti-N-methyl-D-aspartate receptor encephalitis

Analysis of characteristics of movement disorders in patients with anti-N-methyl-D-aspartate receptor encephalitis

Experience with anti NMDA receptor antibody encephalitis in a tertiary care hospital in Pakistan

Diagnostic Uncertainties: Chorea

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