Contemporary advances in anti-NMDAR antibody (Ab)-mediated encephalitis

Seery, Nabil; Butzkueven, Helmut; O’Brien, Terence J.; Monif, Mastura

doi:10.1016/j.autrev.2022.103057

Cited by 20 publications

(20 citation statements)

References 140 publications

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“…As a transmembrane ion channel type glutamate receptor, NMDAR is mainly expressed in nerve cells of the brain and is implicated in modulating brain plasticity, learning, and cognitive function (9). NMDAR has three different subunits, namely NR1, NR2, and NR3 (17).…”

Section: Discussionmentioning

confidence: 99%

“…Notably, anti-NMDAR IgG is most commonly detected in anti-NMDAR encephalitis (18). The main clinical manifestations of anti-NMDAR encephalitis include psychosis, cognitive decline, epileptic seizures, dyskinesia, decreased consciousness, and autonomic instability (9,19). As for the diagnosis of anti-NMDAR encephalitis, there are reliable criteria that assist in identifying the disease on clinical grounds and highly specific antibody tests to confirm the clinical diagnosis (9,19).…”

Section: Discussionmentioning

confidence: 99%

“…The main clinical manifestations of anti-NMDAR encephalitis include psychosis, cognitive decline, epileptic seizures, dyskinesia, decreased consciousness, and autonomic instability (9,19). As for the diagnosis of anti-NMDAR encephalitis, there are reliable criteria that assist in identifying the disease on clinical grounds and highly specific antibody tests to confirm the clinical diagnosis (9,19). Although the patient we reported had positive anti-NMDAR IgG in CSF, he lacked typical clinical manifestations and abnormal EEG, which could not be diagnosed anti-NMDAR encephalitis according to Graus and Dalmau criteria (19).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common form of autoimmune encephalitis caused by autoantibodies to the NMDA receptor (9). Tumors, pathogen infections, systemic autoimmune diseases (ADs), and other unknown factors trigger the release of Abs against NMDAR (9)(10)(11). Some systemic ADs, such as Hashimoto's thyroiditis, systemic lupus erythematosus, urticaria, and allergic purpura, are associated with anti-NMDAR positivity (12,13).…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Rheumatoid meningitis with positive NMDAR antibody: A case treated with intravenous immunoglobulin

Zhang

Wan²,

Mei³

et al. 2022

Front. Immunol.

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As a rare complication of rheumatoid arthritis (RA) in the central nervous system (CNS), rheumatoid meningitis (RM) mainly affects the meninges and has various clinical symptoms. The diagnostic and treatment approaches currently used are not practical. RM cases with positive NMDAR antibodies (Abs) have never been reported. In the present study, a 66-year-old man with a 1-year history of RA presented recurrent left lower limb weakness during activities for 1 month. The results showed that rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) were positive in the serum, and NMDAR Abs were present in cerebrospinal fluid (CSF). Hyperintensity was observed in the leptomeninges of the right frontal and parietal lobes, and subtle hyperintensity was observed in the left frontal and parietal lobes, as indicated by brain MRI. A meningeal biopsy revealed non-specific inflammation with the absence of rheumatoid nodules. The patient was given IVIg on day 7 after admission. The clinical symptoms were relieved, the lesions were alleviated, and abnormal biochemical indicators were gradually recovered 1 week after initiation of the treatment, while NMDAR Abs were present in CSF even after treatment. After 5 months of follow-up, the patient’s serum and CSF ACPA and IL-6 levels were still high. The findings showed that brain MRI was adequate for the diagnosis of RM. ACPA and IL-6 might be the specific biomarkers for disease activity in RM. IVIg was effective as induction therapy for RM. Further studies should explore whether the presence of NMDAR Abs is associated with RM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Case Report: Rheumatoid meningitis with positive NMDAR antibody: A case treated with intravenous immunoglobulin

Zhang

Wan²,

Mei³

et al. 2022

Front. Immunol.

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Parallel electrophysiological abnormalities due to COVID‐19 infection and to Alzheimer's disease and related dementia

Jiang,

Neal,

Sompol

et al. 2024

Alzheimer's & Dementia

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Many coronavirus disease 2019 (COVID‐19) positive individuals exhibit abnormal electroencephalographic (EEG) activity reflecting “brain fog” and mild cognitive impairments even months after the acute phase of infection. Resting‐state EEG abnormalities include EEG slowing (reduced alpha rhythm; increased slow waves) and epileptiform activity. An expert panel conducted a systematic review to present compelling evidence that cognitive deficits due to COVID‐19 and to Alzheimer's disease and related dementia (ADRD) are driven by overlapping pathologies and neurophysiological abnormalities. EEG abnormalities seen in COVID‐19 patients resemble those observed in early stages of neurodegenerative diseases, particularly ADRD. It is proposed that similar EEG abnormalities in Long COVID and ADRD are due to parallel neuroinflammation, astrocyte reactivity, hypoxia, and neurovascular injury. These neurophysiological abnormalities underpinning cognitive decline in COVID‐19 can be detected by routine EEG exams. Future research will explore the value of EEG monitoring of COVID‐19 patients for predicting long‐term outcomes and monitoring efficacy of therapeutic interventions.Highlights Abnormal intrinsic electrophysiological brain activity, such as slowing of EEG, reduced alpha wave, and epileptiform are characteristic findings in COVID‐19 patients. EEG abnormalities have the potential as neural biomarkers to identify neurological complications at the early stage of the disease, to assist clinical assessment, and to assess cognitive decline risk in Long COVID patients. Similar slowing of intrinsic brain activity to that of COVID‐19 patients is typically seen in patients with mild cognitive impairments, ADRD. Evidence presented supports the idea that cognitive deficits in Long COVID and ADRD are driven by overlapping neurophysiological abnormalities resulting, at least in part, from neuroinflammatory mechanisms and astrocyte reactivity. Identifying common biological mechanisms in Long COVID‐19 and ADRD can highlight critical pathologies underlying brain disorders and cognitive decline. It elucidates research questions regarding cognitive EEG and mild cognitive impairment in Long COVID that have not yet been adequately investigated.

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Overlapping rheumatoid meningitis with anti‐N‐methyl‐D‐aspartate receptor encephalitis: A case report

Ide

Kawanami

Tada

et al. 2023

Clinical Case Reports

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Contemporary advances in anti-NMDAR antibody (Ab)-mediated encephalitis

Cited by 20 publications

References 140 publications

Case Report: Rheumatoid meningitis with positive NMDAR antibody: A case treated with intravenous immunoglobulin

Case Report: Rheumatoid meningitis with positive NMDAR antibody: A case treated with intravenous immunoglobulin

Parallel electrophysiological abnormalities due to COVID‐19 infection and to Alzheimer's disease and related dementia

Overlapping rheumatoid meningitis with anti‐N‐methyl‐D‐aspartate receptor encephalitis: A case report

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