Anti N-methyl-D-aspartate receptor (NMDAr) encephalitis during pregnancy: A case report

Evangelista, Giacomo; Consoli, Stefano; Scorrano, Giovanna; Russo, Mirella; Pietro, Martina Di; Onofrj, Marco; Sensi, Stefano L.; Anzellotti, Francesca

doi:10.1016/j.ebr.2022.100535

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…Numerous reports in the obstetric literature detail the use of IV Ig therapy to address various conditions encountered during pregnancy [37]. Additionally, several case reports and series have demonstrated positive outcomes in pregnant patients with autoimmune epilepsies (AEs) treated with IV Ig, with a low incidence of side effects and infectious complications [31]. In our case, the treatment with corticosteroids and Rituximab was initiated after the cesarean section delivery, and plasma exchange (PLEX) was not required.…”

Section: Discussionmentioning

confidence: 88%

The Management and Diagnosis of Anti-NMDA Receptor Autoimmune Encephalitis in Pregnant Women: A Case Report and Literature Review

Potorac,

Varlas,

Borș

et al. 2023

Medicina

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Rationale: Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune synaptic encephalitis, often mediated by neuronal surface antibodies. Clinically, it manifests through a diverse range of neurological and psychiatric symptoms, primarily affecting young women with ovarian teratoma, which is rare in pregnant women. Patient concerns: We report a case of a 35-year-old multiparous pregnant patient at 38 weeks of gestation presented to the emergency room with seizure, psychiatric symptoms like delirious speech with mystical visual and auditory hallucinations, bradylalia, and retrograde amnesia. Diagnosis: The diagnosis of autoimmune encephalitis with anti-NMDA antibodies was concluded by considering the lumbar puncture results, brain imaging, and the patient’s persistent symptoms. Outcomes: This case is noteworthy for its rarity and the symptoms’ breadth. At 38 weeks of gestation, the patient underwent a cesarean section, resulting in excellent maternal recovery observed during the 6-month follow-up and good neonatal adaptation. Lessons: Our goals include raising awareness about this condition and emphasizing the significance of early diagnosis. This encephalitis is treatable and potentially reversible, underscoring the importance of prompt identification.

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Section: Discussionmentioning

confidence: 88%

The Management and Diagnosis of Anti-NMDA Receptor Autoimmune Encephalitis in Pregnant Women: A Case Report and Literature Review

Potorac,

Varlas,

Borș

et al. 2023

Medicina

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“…The majority of publications included in this review were the 14 case reports for lacosamide. [18][19][20][21][22][23][24][25][26][27][28][29][30][31] The other publications on lacosamide included nine case series, [32][33][34][35][36][37][38][39][40] one retrospective cohort study, 41 and two pharmacovigilance safety reports. 42,43 Ben-Menachem et al reported in a multicenter open-label trial that two individuals became pregnant.…”

Section: Synthesis Of Results From Included Studiesmentioning

confidence: 99%

Third generation antiseizure medications exposure during pregnancy and neonatal adverse birth outcomes: A systematic review

Goubran,

Okunnu,

Lavu

et al. 2024

Science Progress

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Background: Third generation antiseizure medications (ASMs) are currently used for seizure control as well as several other indications, including pain management and psychiatric disorders. As a result, maternal exposure to third generation ASMs during pregnancy has become increasingly prevalent. The current systematic review aimed to summarize the published evidence on third generation ASMs and their effect on preterm birth, cesarean section (c-section) and fetal loss. Methods: The following databases were searched: Medline, Embase, International Pharmaceutical Abstracts, Cochrane Library and Scopus until September 2022. Results: We screened 2987 studies, and identified 32 studies or case reports for inclusion, however only one study utilized a control group. Narrative systematic evidence synthesis was conducted for brivaracetam, eslicarbazepine, fosphenytoin, lacosamide and perampanel. Conclusion: Due to the scarcity and quality of published studies, drawing clear-cut conclusions regarding third generation ASMs and the outcomes of interest is challenging. More comparative safety studies focusing on neonatal safety of third generation ASMs in pregnancy are essential.

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“…According to Newcastle–Ottawa Quality Assessment Scale (NOS), 16 articles received a score of 5, 19 articles had a score of 4, and 5 articles were scored 3 (score results in detail are shown in Table S4). Details of the included articles are reported in Table 1 7,12–51 …”

Section: Resultsmentioning

confidence: 99%

Autoimmune encephalitis during pregnancy: A diagnostic and therapeutic challenge—A systematic review with individual patients' analysis and clinical recommendations

et al. 2023

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SUMMARYSeveral reports have described the autoimmune encephalitis’ (AE) possible onset during pregnancy. In this systematic review, we summarize the available data on the diagnostic and therapeutic approach to AE during pregnancy, highlighting the associated maternal and fetal clinical outcomes. A systematic search of the literature was performed. The following databases were used: Pubmed, Google Scholar, EMBASE, CrossRef. The revision was registered on the PROSPERO platform (CRD42022336357). Forty‐nine patients were included. AE onset was mainly observed during the first and the second trimester of pregnancy with psychiatric manifestations and seizures as main onset symptoms. CSF analysis showed AE‐specific autoantibody positivity in 33 patients (anti‐NMDA receptor as the most frequent). EEG generally showed normal findings. MRI revealed pathological findings in less than half of patients. Tumor screening was positive findings in 14 cases. First line immunotherapy (single or combined) was generally employed while second line was administered in a minority of patients. Levetiracetam was the most used antiseizure medication. Cesarean section was performed in 18 women. Most of the women had an excellent early outcome after delivery but 22 showed persistent neurological deficits in long‐term follow‐up. Fetal outcome was positive in 33 cases whereas 12 cases of fetal death were reported. A logistic regression showed that no variable significantly influenced the odds of good/bad maternal and fetal clinical outcome. Diagnosis and treatment of AE during pregnancy is challenging. The rate of miscarriage in women with AE seems to be higher than the general population. In addition, mothers may show long‐term neurological deficits.

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Anti N-methyl-D-aspartate receptor (NMDAr) encephalitis during pregnancy: A case report

Cited by 5 publications

References 34 publications

The Management and Diagnosis of Anti-NMDA Receptor Autoimmune Encephalitis in Pregnant Women: A Case Report and Literature Review

The Management and Diagnosis of Anti-NMDA Receptor Autoimmune Encephalitis in Pregnant Women: A Case Report and Literature Review

Third generation antiseizure medications exposure during pregnancy and neonatal adverse birth outcomes: A systematic review

Autoimmune encephalitis during pregnancy: A diagnostic and therapeutic challenge—A systematic review with individual patients' analysis and clinical recommendations

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