Adjunct therapeutic plasma exchange for anti‐<i>N</i>‐methyl‐<scp>D</scp>‐aspartate receptor antibody encephalitis: A case report and review of literature

Mirza, M. B.; Pogoriler, Jennifer; Paral, Kristen M.; Ananthanarayanan, Vijayalakshmi; Mandal, Saptarshi; Mazin, Abdul; Baron, Beverly W.; Richa, Elie

doi:10.1002/jca.20312

Cited by 20 publications

(7 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For first-line treatments (as reported as first agent given or delineated in report), 335 (89.8%) received high-dose corticosteroids, 296 received IVIG (79.3%), and 116 (31%) received therapeutic plasma exchange. Five patients received electroconvulsive therapy (ECT) ( 34 , 46 , 50 – 52 ), and 14 children required mechanical ventilation ( 11 , 12 , 22 , 28 , 37 , 38 , 42 , 44 , 52 , 53 , 55 , 56 ). There were five reports that explicitly defined the use of intensive care or pediatric intensive care unit although some reports alluded to need for “advanced” therapies ( 30 , 34 , 38 , 54 , 55 ).…”

Section: Resultsmentioning

confidence: 99%

Pediatric Anti-N-Methyl-d-Aspartate Receptor Encephalitis: A Review with Pooled Analysis and Critical Care Emphasis

et al. 2017

View full text Add to dashboard Cite

PurposeAnti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is being recognized with increasing frequency among children. Given the paucity of evidence to guide the critical care management of these complex patients, we provide a comprehensive review of the literature with pooled analysis of published case reports and case series.MethodsWe performed a comprehensive literature search using PubMed, Scopus, EMBASE, and Web of Science for relevant published studies. The literature search was conducted using the terms NMDA, anti-NMDA, Anti-N-methyl-d-aspartate, pediatric encephalitis, and anti-NMDAR and included articles published between 2005 and May 1, 2016.ResultsForty-eight references met inclusion criteria accounting for 373 cases. For first-line treatments, 335 (89.8%) received high-dose corticosteroids, 296 received intravenous immunoglobulin (79.3%), and 116 (31%) received therapeutic plasma exchange. In these, 187 children (50.1%) had a full recovery with only minor deficits, 174 patients (46.7%) had partial recovery with major deficits, and 12 children died. In addition, 14 patients were reported to require mechanical ventilation.ConclusionAnti-NMDA encephalitis is a formidable disease with great variation in clinical presentation and response to treatment. With early recognition of this second most common cause of pediatric encephalitis, a multidisciplinary approach by physicians may provide earlier access to first- and second-line therapies. Future studies are needed to examine the efficacy of these current therapeutic strategies on long-term morbidity.

show abstract

Section: Resultsmentioning

confidence: 99%

Pediatric Anti-N-Methyl-d-Aspartate Receptor Encephalitis: A Review with Pooled Analysis and Critical Care Emphasis

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The authors concluded that plasmapheresis might have at least accelerated recovery. Interestingly, Kamran Mirza et al 136 described the case of a 14-year-old with anti-NMDAr encephalitis and catatonia who failed therapy with intravenous steroids, IVIg, one dose of rituximab, 7 sessions of ECT and who presented no improvement with plasmapheresis. • Ryan et al 66 described the case of a 37-year-old woman with anti-NMDAr encephalitis and catatonia treated with intravenous steroids and immunoglobulins, cyclophosphamide, and rituximab with an almost full recovery after 4 months of treatment, with the authors attributing the favorable response primarily to rituximab.…”

Section: Encephalitismentioning

confidence: 99%

Catatonia secondary to anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis: a review

Macedo

Marques

2019

CNS Spectr.

View full text Add to dashboard Cite

Anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis is a relatively recent autoimmune entity, as it was first described in 2007. Given that it is a condition with neuropsychiatric symptoms, its initial symptom is frequently psychiatric in nature. Hence, psychiatrists are often the first physicians to assess these patients and, as so, must recognize this type of encephalitis as a possible cause. Catatonia may be inaugural or develop throughout the course of the disease. Management of patients with anti-NMDAr encephalitis is based on etiologic treatment with immunotherapy and removal of the associated tumor, if any. However, these catatonic patients may have variable responses to etiologic treatment, sometimes with refractory catatonic symptoms, which attests to the necessary urgency to know how to manage these patients. In the clinical setting, physicians appear to be using guidelines originally created to the management of catatonia due to primary psychiatric conditions. In this literature review, catatonia was historically contextualized and anti-NMDAr encephalitis overall described. Finally, catatonia secondary to this type of encephalitis was discussed.

show abstract

“…ECT for psychiatric symptoms of autoimmune encephalitis has not been well studied. Some improvement in psychotic and catatonic symptoms was reported in several anti-NMDAR encephalitis patients with inadequate responses to other treatments,27 but the combination of ECT with immunotherapy and plasma exchange failed in a 14-year-old girl with anti-NMDAR encephalitis who presented with typical signs and symptoms of catatonia 29. Although our patient responded positively to antipsychotics during earlier psychotic episodes, her condition deteriorated to a likely neuroleptic malignant syndrome after one MECT session during the most recent episode.…”

Section: Discussionmentioning

confidence: 99%

Anti-N-methyl-d-aspartate receptor encephalitis in a patient with a 7-year history of being diagnosed as schizophrenia: complexities in diagnosis and treatment

Huang¹,

Kang²,

Zhang³

et al. 2015

NDT

View full text Add to dashboard Cite

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune encephalitis associated with antibodies against the NR1 subunits of NMDARs. Although new-onset acute prominent psychotic syndromes in patients with NMDAR encephalitis have been well documented, there is a lack of case studies on differential diagnosis and treatment of anti-NMDAR encephalitis after a long-term diagnostic history of functional psychotic disorders. The present study reports an unusual case of anti-NMDAR encephalitis. The patient had been diagnosed with schizophrenia 7 years earlier, and was currently hospitalized for acute-onset psychiatric symptoms. The diagnosis became unclear when the initial psychosis was confounded with considerations of other neurotoxicities (such as neuroleptic malignant syndrome). Finally, identification of specific immunoglobulin G NR1 autoantibodies in the cerebrospinal fluid and greater effectiveness of immunotherapy over antipsychotics alone (which has been well documented in anti-NMDAR encephalitis) indicated the diagnosis of anti-NMDAR encephalitis in this case. Based on the available evidence, however, the relationship between the newly diagnosed anti-NMDAR encephalitis and the seemingly clear, long-term history of schizophrenia in the preceding 7 years is uncertain. This case report illustrates that psychiatrists should consider anti-NMDAR encephalitis and order tests for specific immunoglobulin G NR1 autoantibodies in patients presenting with disorientation, disturbance of consciousness, cognitive deficit, dyskinesia, autonomic disturbance, or rapid deterioration, even with a seemingly clear history of a psychiatric disorder and no specific findings on routine neuroimaging, electroencephalography, or cerebrospinal fluid tests in the early stage of the illness.

show abstract

Adjunct therapeutic plasma exchange for anti‐N‐methyl‐D‐aspartate receptor antibody encephalitis: A case report and review of literature

Cited by 20 publications

References 12 publications

Pediatric Anti-N-Methyl-d-Aspartate Receptor Encephalitis: A Review with Pooled Analysis and Critical Care Emphasis

Pediatric Anti-N-Methyl-d-Aspartate Receptor Encephalitis: A Review with Pooled Analysis and Critical Care Emphasis

Catatonia secondary to anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis: a review

Anti-N-methyl-d-aspartate receptor encephalitis in a patient with a 7-year history of being diagnosed as schizophrenia: complexities in diagnosis and treatment

Contact Info

Product

Resources

About