Voltage-gated Potassium Channel Antibody Autoimmune Encephalopathy Presenting With Isolated Psychosis in an Adolescent

Pon, Natalie C; Houck, Kimberly; Muscal, Eyal; Idicula, Sindhu A

doi:10.1097/pra.0000000000000265

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…En los estudios realizados en niños ningún paciente presentó convulsiones distónicas faciobraquiales o hiponatremia, hallazgos comunes en pacientes adultos con Ac IgG LGI1 positivo (18,41) . Sin embargo, las convulsiones focales fueron frecuentes en pacientes pediátricos positivos para IgG LGI-1 (múltiples episodios por día) (9,18,42,43) . En algunos pacientes predominó la afectación del sistema nervioso periférico (SNP), con neuropatía axonal dolorosa y disautonomía (18) .…”

Section: Encefalitis Por Ac Lgi1unclassified

Espectro clínico de la Encefalitis Autoinmune no NMDAR en pediatría

Tamayo-Medina,

Osorio-Ruiz,

González

et al. 2023

Rev. chil. neuro-psiquiatr.

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This work presents a narrative review of the main findings in the medical literature on the clinical manifestations of pediatric autoimmune encephalitis (PAE) not mediated by anti-N-methyl-Daspartate acid receptor (NMDAR) antibodies. Prominent PAEs are associated with specific antibodies, such as the voltage-gated potassium channel complex, glutamic acid decarboxylase, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, and alpha-amino -3-hydroxy-5. -methyl-4isoxazolepropionic acid receptor. -gamma-aminobutyric. Diagnosis of this pathology is a challenge in pediatrics due to the complexity of psychiatric and neurological manifestations generated by involvement of cortex, limbic system, brainstem, basal ganglia and cerebellum. In turn, understanding its symptoms allows identifying the overlap in clinical presentations between the different types of PAE and the differential diagnosis with other inflammatory diseases of the brain, infections, metabolic diseases and psychiatric disorders. Biomedical knowledge and clinical suspicion of non-NMDAR PAE establishes a growing field of research in neuropsychiatry and favors the diagnosis and treatment of underdiagnosed encephalitides.

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Section: Encefalitis Por Ac Lgi1unclassified

Espectro clínico de la Encefalitis Autoinmune no NMDAR en pediatría

Tamayo-Medina,

Osorio-Ruiz,

González

et al. 2023

Rev. chil. neuro-psiquiatr.

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“…42) An acute and isolated psychotic manifestation of antiVGKC encephalitis was recently reported in a 16-year-old girl, but further studies are required to recognize potential new antibodies against neuronal structures. 43)…”

Section: ) Vgkc-positive Encephalitis In the Absence Of Anti-lgi1 Anmentioning

confidence: 99%

“…These patients have a heterogeneous clinical spectrum, including pain syndrome, LE, epilepsy, polyneuropathy, and cramp fasciculation syndromes, all associated with the demonstration of anti-VGKC autoantibodies [ 42 ]. An acute and isolated psychotic manifestation of anti-VGKC encephalitis was recently reported in a 16-year-old girl, but further studies are required to recognize potential new antibodies against neuronal structures [ 43 ].…”

Section: Specific Autoimmune Encephalitis Syndromementioning

confidence: 99%

Autoimmune encephalitis and epilepsy: evolving definition and clinical spectrum

Seo

Lee

et al. 2020

Clin Exp Pediatr

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Advances in autoimmune encephalitis studies in the past 10 years have led to the identification of new syndromes and biomarkers that have transformed the diagnostic approach to the disorder. The disorder or syndrome has been linked to a wide variety of pathologic processes associated with the neuron-specific autoantibodies targeting intracellular and plasma membrane antigens. However, current criteria for autoimmune encephalitis are quite dependent on antibody testing and responses to immunotherapy, which might delay the diagnosis. This form of encephalitis can involve the multifaceted presentation of seizures and unexpected behavioral changes. The spectrum of neuropsychiatric symptoms in children is less definitive than that in adults, and the incorporation of clinical, immunological, electrophysiological, and neuroradiological results is critical to the diagnostic approach. In this review, we document the clinical and immunologic characteristics of autoimmune encephalitis known to date, with the goal of helping clinicians in differential diagnosis and to provide prompt and effective treatment.

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“…Patients with NMDA receptor and VGKC encephalitis not infrequently present with acute psychosis to psychiatrists first (13)(14)(15)(16). Most cases go on to develop neurological symptoms which would then trigger an evaluation for non-psychiatric illness, including infectious, autoimmune, neurodegenerative, and metabolic disorders which may cause psychotic symptoms.…”

mentioning

confidence: 99%

N-Methyl-D-Aspartate(NMDA) Receptor and Voltage-Gated Potassium Channel (VGKC) Antibody-Associated Encephalitides Presenting as First Episode Acute Psychosis

et al. 2019

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Aim: Acute psychosis is not an uncommon presenting feature in immune-mediated encephalitides. Most patients improve if properly diagnosed and treated expediently with immunotherapy. Our study aimed to describe the frequency, clinical spectrum, and longterm outcomes in patients presenting with acute psychosis who have anti-N-methyl-Daspartate (NMDA) receptor or anti-voltage-gated potassium channel (VGKC) encephalitis. Method:We recruited patients aged 16-50 years presenting with less than 1 month of psychotic and neurological symptoms including cognitive dysfunction, seizures, abnormal movements, and/or autonomic dysfunction.Results: Between September 2011 and October 2013, 60 patients with first episode acute psychosis were screened; 15 were recruited and included for analyses. Four (26.7%) patients were diagnosed with anti-NMDA receptor encephalitis and 1 (6.7%) with anti-VGKC encephalitis. We found that the mean serum white blood cell (WBC) count (12.8 × 10 9 /L ± 4.8 vs. 7.9 × 10 9 /L ± 2.6; p = 0.05) and cerebrospinal fluid WBC count (106 cells/ µl ± 101 vs. 8.5 cells/µl ± 18.9; p = 0.05) were higher in positive cases. Certain prodromal features such as fever, headache, confusion, facial dyskinesia, and hypersalivation were also more likely to be present in positive cases. Patients with autoimmune encephalitis also tended to be more unwell, with the majority requiring intensive care, had lower global assessment of functioning scores (30 ± 10 vs. 53.7 ± 21.2, p = 0.09), and were not well enough to complete standard psychiatric and cognitive assessments at presentation.Conclusion: Autoimmune encephalitis is not uncommon in patients with acute psychosis. Elevated WBC counts, certain prodromal features, and a more severe illness at presentation should prompt appropriate evaluation.

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Voltage-gated Potassium Channel Antibody Autoimmune Encephalopathy Presenting With Isolated Psychosis in an Adolescent

Cited by 9 publications

References 21 publications

Espectro clínico de la Encefalitis Autoinmune no NMDAR en pediatría

Espectro clínico de la Encefalitis Autoinmune no NMDAR en pediatría

Autoimmune encephalitis and epilepsy: evolving definition and clinical spectrum

N-Methyl-D-Aspartate(NMDA) Receptor and Voltage-Gated Potassium Channel (VGKC) Antibody-Associated Encephalitides Presenting as First Episode Acute Psychosis

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