Anti-NMDA Receptor Encephalitis: Diagnosis, Psychiatric Presentation, and Treatment

Chapman, Michael P.; Vause, Holly E.

doi:10.1176/appi.ajp.2010.10020181

Cited by 153 publications

(165 citation statements)

References 21 publications

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“…The efficacy of both classical and atypical antipsychotics and benzodiazepines alone or in combination was very limited in this patient population, as previously described (13,28). As a result, the 13 patients treated with psychotropic medication received one to four different antipsychotics and one to four different benzodiazepines.…”

Section: Discussionmentioning

confidence: 70%

Psychiatric phenomena as initial manifestation of encephalitis by anti‐NMDAR antibodies

Maat

Graaff

Beveren

et al. 2013

Acta Neuropsychiatr.

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Objective: Autoimmune encephalitis associated with autoantibodies against the N -methyl-d-aspartate receptor (NMDAR) often presents with behavioural change. Our objective was to describe in detail the psychiatric presentation and pathways to care in order to aid the early diagnosis of NMDAR encephalitis. Methods: Sera and cerebrospinal fluid (CSF) from patients with suspected NMDAR encephalitis were tested on HEK 293 cells transfected with the NR1 subunit of the NMDAR. Clinical information was obtained from the referring psychiatrists and neurologists and by review of the clinical records. Results: Samples from 15 patients (13 female, 2 male, mean age 24 years, range 5-56 years) tested anti-NMDAR positive. Twelve of the 15 patients (80%) presented with prominent psychiatric symptoms and 8 were initially referred to a psychiatric service. The most prominent initial psychiatric symptoms were anxiety in seven (47%), behavioural change (often bizarre) in six (40%) and agitation in five (33%). All patients developed psychiatric symptoms in the first 6 weeks of illness. Thirteen patients received psychotropic medications: antipsychotics in 12 and benzodiazepines in 11. Treating physicians considered the psychotropic medication not effective in 11 patients resulting in many drug switches. At nadir, all patients were in a very poor condition. However, eight patients (53%) recovered (almost) completely. Outcome tended to be better in patients who had received early immunotherapy or tumour removal. Conclusions: Autoimmune encephalitis and anti-NMDAR testing in serum and CSF should be considered in patients, especially young females, presenting with atypical psychiatric phenomena. Early diagnosis and treatment will likely improve the prognosis of NMDAR encephalitis. Significant outcomes• In this first Dutch cohort of patients with N -methyl-d-aspartate receptor (NMDAR) encephalitis, 80%presented with psychiatric symptoms while 62% were initially referred to a psychiatric service.• Apart from testing for anti-NMDAR antibodies in serum and/or cerebrospinal fluid (CSF) the most sensitive ancillary investigations were electroencephalography (EEG) (abnormal in 100% of tested patients), CSF routine examination (abnormal in 93%) and magnetic resonance imaging (MRI) (abnormal in 40%).• This study supports the idea that early recognition and treatment of NMDAR encephalitis results in better outcome.• Symptomatic antipsychotic therapy was generally ineffective on its own and required many drug switches until the inflammatory process was treated.

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Section: Discussionmentioning

confidence: 70%

Psychiatric phenomena as initial manifestation of encephalitis by anti‐NMDAR antibodies

Maat

Graaff

Beveren

et al. 2013

Acta Neuropsychiatr.

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“…7,9 Management of the acute and prolonged neuropsychiatric symptoms is receiving increased attention, and clinical experience suggests that despite a psychotic picture at times, high-potency dopaminergic blockade might not address symptoms as effectively as more sedating medications (MSK, JD, unpublished observations). 16 …”

Section: Autoimmune Synaptic Encephalitismentioning

confidence: 99%

The Emerging Link Between Autoimmune Disorders and Neuropsychiatric Disease

Kayser¹,

Dalmau²

2011

Journal of Neuropsychiatry

115

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“…Benzodiazepines (lorazepam) can be effective in cases of catatonia, but few published reports describe the use of electroconvulsive therapy if catatonia is benzodiazepines-resistant [15,17,18]. Anecdotal case reports show that lithium and valproic acid use can treat mood dysregulation symptoms in anti-NMDAR encephalitis [19,20]. In our case, the use of quetiapine up to 600 mg/day after 3-4 weeks coupled with high doses of benzodiazepines (midazolam 4 mg i.v.…”

Section: Pharmacological Strategiesmentioning

confidence: 82%

“…There is limited literature for the long-term rehabilitation of patients with anti-NMDAR encephalitis. A recent clinical case conference demonstrated the necessity of individualizes treatments and targeting different strategies depending on the type of clinical presentation [20]. The authors suggested combining physical and occupational therapies to target different deficits after a long hospital stay.…”

Section: Rehabilitation Challengesmentioning

confidence: 99%

Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A New Challenging Entity for Consultation-Liaison Psychiatrist

Ge¹,

Ao²,

Dalmau³

et al. 2016

Brain Disord Ther

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Background-Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a relatively newly identified autoimmune neuropsychiatric disorder that predominantly affects children and young adults. Although psychiatric symptoms are highly prevalent and frequently severe, it has mainly been reported in neurological, but not psychiatric, literature. Understanding this form of encephalitis, its quick diagnosis and which treatment to provide are of utmost importance for consultation-liaison (C-L) psychiatrists. The aim of this paper was to describe a case of anti-NMDAR encephalitis with severe psychiatric manifestations, who showed impressive recovery but required intensive involvement of the C-L psychiatry team. We emphasise the behavioural aspects, psychiatric symptoms and challenges faced by the CL consultant across the different phases of the treatment.

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Anti-NMDA Receptor Encephalitis: Diagnosis, Psychiatric Presentation, and Treatment

Cited by 153 publications

References 21 publications

Psychiatric phenomena as initial manifestation of encephalitis by anti‐NMDAR antibodies

Psychiatric phenomena as initial manifestation of encephalitis by anti‐NMDAR antibodies

The Emerging Link Between Autoimmune Disorders and Neuropsychiatric Disease

Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A New Challenging Entity for Consultation-Liaison Psychiatrist

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