An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models

@article{Dalmau2019AnUO,
  title={An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models},
  author={Josep Dalmau and Tha{\'i}s Armangu{\'e} and Jes{\'u}s Planagum{\`a} and Marija Radosevic and Francesco Mannara and Frank Leypoldt and Christian Geis and Eric Lancaster and Maarten J. Titulaer and Myrna R. Rosenfeld and Francesc Graus},
  journal={The Lancet Neurology},
  year={2019},
  volume={18},
  pages={1045-1057}
}
The identification of anti-NMDA receptor (NMDAR) encephalitis about 12 years ago made it possible to recognise that some patients with rapidly progressive psychiatric symptoms or cognitive impairment, seizures, abnormal movements, or coma of unknown cause, had an autoimmune disease. In this disease, autoantibodies serve as a diagnostic marker and alter NMDAR-related synaptic transmission. At symptom onset, distinguishing the disease from a primary psychiatric disorder is challenging. The… Expand
A Case of Anti-NMDA Receptor Encephalitis with Normal Findings on Initial Diagnostic Tests
TLDR
A patient who presented with acute onset of psychosis with normal EEG, and normal brain MRI, and non-inflammatory CSF initially is reported, using diagnostic tests such as cerebrospinal fluid (CSF) analysis, electroencephalogram (EEG), and magnetic resonance imaging (MRI) as integral supportive findings. Expand
Anti-NMDAR encephalitis for psychiatrists: the essentials.
TLDR
The gold standard for testing is the detection of NMDAR antibodies in cerebrospinal fluid, but serum can be tested as a more accessible (but less reliable) preliminary step. Expand
Psychiatric management of anti-NMDAR encephalitis: a cohort analysis
TLDR
Although there was an 88% reduction in cases with aggression, there was little improvement in psychosis, affective symptoms or catatonia with antipsychotics alone, and psychiatric input is imperative for both acute and longer-term management of anti-NMDAR encephalitis. Expand
Case Report: Severe Adolescent Major Depressive Syndrome Turns Out to Be an Unusual Case of Anti-NMDA Receptor Encephalitis
TLDR
Surprisingly, pleocytosis and anti-NMDAR autoantibodies are found in the cerebrospinal fluid (CSF) of an 18-year-old female high school student with a rapid onset severe depressive syndrome, despite an otherwise unremarkable diagnostic workup. Expand
Anti-NMDA receptor encephalitis and overlapping demyelinating disorder in a 20-year old female with borderline personality disorder: proposal of a diagnostic and therapeutic algorithm for autoimmune encephalitis in psychiatric patients “case report”
TLDR
Continuous awareness for neuropsychiatric clinical warning signs in patients with a pre-diagnosed psychiatric disorder is important for a timely diagnosis, and the diagnostic and therapeutic algorithm provided here, for the first time, can be a useful tool. Expand
Current Progress on Assessing the Prognosis for Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis
TLDR
Current advances of prognosis-related research from the clinical manifestations of the disease and auxiliary examinations such as EEG, magnetic resonance imaging (MRI), 18F fluorodeoxyglucose positron emission tomography (FDG-PET), and antibody measurement are reviewed. Expand
Fatal Autoimmune Anti-NMDA-Receptor Encephalitis with Poor Prognostication Score in a Young Kenyan Female
TLDR
A young Kenyan female who was transferred to a facility with headaches, insomnia, behaviour changes and latterly pathognomonic orofacial dyskinesias succumbed to septic shock from prolonged intensive care and was comprehensively ruled out infectious and other inflammatory/auto-immune causes. Expand
Longitudinal analysis of regional brain changes in anti-NMDAR encephalitis: a case report
TLDR
The results suggest that reversible cortical volume loss in anti-NMDA encephalitis has a regional specificity that mirrors many of the clinical symptoms associated with the disorder and tracks the dynamics of disease severity over time. Expand
Bilateral thalamic changes in anti-NMDAR encephalitis presenting with hemichorea and dystonia and acute transient psychotic disorder
TLDR
This case not only highlights that the combination of hemichorea and dystonia can be features of anti-NMDAR encephalitis, but adds novelty by bilateral symmetric thalamic changes. Expand
Neurocritical care for Anti-NMDA receptor encephalitis
TLDR
The clinical presentations of the acute stage of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis and the neurocritical care strategy in intensive care units are summarized. Expand
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 105 REFERENCES
Anti-NMDA Receptor Encephalitis in Psychiatry.
TLDR
Up to date review of anti-NMDA receptor encephalitis is provided and the role of psychiatry is highlighted in diagnosis, symptomatology, and treatment. Expand
The Psychiatric Phenotype of Anti-NMDA Receptor Encephalitis.
TLDR
Patients with anti-NMDAR encephalitis present with a somewhat distinct cluster of psychiatric symptoms not commonly seen in functional psychoses, and the more prominent psychotic features in younger adults may reflect greater susceptibility of the young brain to exogenous psychosis. Expand
Neuroleptic intolerance in patients with anti-NMDAR encephalitis
TLDR
Several psychiatric presentations were observed in patients with anti-NMDAR encephalitis, although none was specific; however, patients, mostly women, also had discreet neurologic signs that should be carefully assessed as well as signs of antipsychotic intolerance that should raise suspicion for anti- NMDAREncephalitis. Expand
Neuropsychological And Psychopathological Profile Of Anti-Nmdar Encephalitis: A Possible Pathophysiological Model For Pediatric Neuropsychiatric Disorders.
TLDR
Children diagnosed with anti-NMDAR encephalitis were found to have behavioral and psychological deficits pointing to a more comprehensive framework of frontal-subcortical dysfunction, in which the NMDA mediated transmission appear to have a role, as suggested by neurobiological, pharmacological, and neuroimaging studies. Expand
Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies
TLDR
A well-defined set of clinical characteristics are associated with anti-NMDA-receptor encephalitis and the pathogenesis of the disorder seems to be mediated by antibodies. Expand
[Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis: experience with six pediatric patients. Potential efficacy of methotrexate].
TLDR
Although it is a small series and it would be advisable to increase the number and time to progression, methotrexate is seen as an excellent alternative immunomodulator treatment for this pathology. Expand
Electroconvulsive therapy for anti-N-methyl-d-aspartate (NMDA) receptor encephalitis: A systematic review of cases
TLDR
ECT appears to be an effective and safe adjuvant treatment in anti-NMDA receptor encephalitis, particularly for catatonia. Expand
The Movement disorder associated with NMDAR antibody-encephalitis is complex and characteristic: an expert video-rating study
TLDR
Ratings from seven experts across 76 videos were used to better define the MD in NMDAR-AbE, and a clearer description will facilitate confident recognition and enable earlier immunotherapy administration in N-methyl-D-aspartate receptor antibody-mediated encephalitis. Expand
The psychopathology of NMDAR-antibody encephalitis in adults: a systematic review and phenotypic analysis of individual patient data
TLDR
Constrained combination and principal component analyses found that mixtures of mood and psychosis syndromes fit each patient better than any single diagnosis alone, particularly for the patients in the psychiatric-described subgroup. Expand
Frequency and characteristics of isolated psychiatric episodes in anti–N-methyl-d-aspartate receptor encephalitis.
TLDR
In patients with new-onset psychosis, having a history of encephalitis, subtle neurological symptoms, and/or abnormal results on ancillary tests should prompt screening for NMDAR antibodies. Expand
...
1
2
3
4
5
...