Clinical specificities of adult male patients with NMDA receptor antibodies encephalitis

Abstract

Adult male patients who have partial seizures, normal MRI results, and no clear etiology should be tested for NMDAr-Abs to avoid any delays in treatment initiation. Adult female patients who had a seizure as the first symptom are infrequent when NMDAr-Abs encephalitis is diagnosed; additionally, their clinical pattern is different from male patients, with more generalized seizures and rapid development of behavioral and psychiatric symptoms. The differences in hormonal influence could contribute to this difference in clinical pattern.

“Autoimmune Epilepsy”: Encephalitis with Autoantibodies for Epileptologists

“…Encephalitic histopathology All except NMDAR [29]); in these patients, other CNS symptoms evolved within 1 to 17 days (29, 27) emphasizing again the importance of antibody testing especially in patients with complex phenotypes.…”

Temporal Lobe Epilepsy and Autoimmunity

“…[37] NMDAR-ensefalitlerinde ayrıca semiritmik göz, ağız, gövde ve ekstremite hareketleri ile opistotonus ve distoni karşımıza çıkan hareket bozukluklarıdır. [36,37] Ensefalit öncesinde prodromal dönemde başağrısı, üst solunum yolu enfeksiyonu, gastrointestinal sistem enfeksiyonu karşımıza çıkabilir. NMDA ensefaliti tanısı almış hastalarda cinsiyet dominansı kadın lehine olup, bu hastalarda over teratomu sıklığı artmıştır.…”

“…Kadın hastalarda klinik başlangıcında sık-lıkla psikiyatrik ve davranışsal semptomlar izlenirken erkek hastalarda nöbet ile başlangıç görece sık olarak gözlenir. [37] Akut başlangıçlı psikozla seyreden olgularda da NMDA-R antikor pozitifliği bildirilmiştir. [9,38] NMDA otoantikorlarının TLE ile ilişkisi VGKC otoantikorlarına göre daha geri planda gibi görünmekle ile birlikte Dalmau ve ark.nın (2008) bildirdiği 100 hastalık NMDA ensefaliti serisinde 79 hastada nöbet saptanmıştır.…”

Botulinum toxin treatment for hypersalivation in anti‐NMDA receptor encephalitis

“…Anti‐ N ‐methyl‐ d ‐aspartate receptor (NMDAR) encephalitis is an autoimmune synaptic disorder caused by autoantibodies directed against GluN1 subunit of the anti‐NMDAR, resulting in psychosis, loss of consciousness, memory deficits, seizure, speech problems, dyskinesia, autonomic dysfunction, and central hypoventilation 1, 2, 3, 4. By the first‐line immunotherapy (steroids, immunoglobulins, or plasma exchange) and second‐line immunotherapy (rituximab or cyclophosphamide), about 80% of patients with anti‐NMDAR encephalitis recovers favorably to be able to look after own affairs without assistance 5.…”