Letter to the Editor: NMDA receptor autoimmunity in mania following HSV encephalitis

Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin

“…Interpretation of such abnormalities, however, is confounded by the effects of psychiatric (particularly antipsychotic) drugs on the EEG. By contrast, a very typical EEG pattern, extreme delta brush (delta waves with superimposed beta waves (brush), EDB) 64 has been observed in 6.7% of NMDAR-Ab patients 65 ; although only rarely seen in patients with isolated psychotic presentations and NMDAR-Abs in CSF or serum, occasionally in a less widespread 'EDB-like pattern' with fast waves superimposed on delta waves 53,66,67 (Figure 2), it is a potentially important sign of NMDAR-Ab pathology.…”

Unmasking bipolarity in recurrent depressive disorder following herpes simplex virus triggered n‐methyl‐D‐aspartate encephalitis

“…A systematic review found that HSV‐induced NMDA encephalitis is commonly associated with movement disorders; however, psychiatric symptoms are relatively less common 1 . HSV‐induced NMDA encephalitis has been described as presenting with manic symptoms 2 . Another case report described a known case of bipolar disorder, who presented with atypical treatment‐resistant depressive episodes, and later turned out to be anti‐NMDA receptor encephalitis due to HSV‐1 infection 3 .…”

“…encephalitis has been described as presenting with manic symptoms. 2 Another case report described a known case of bipolar disorder, who presented with atypical treatment-resistant depressive episodes, and later turned out to be anti-NMDA receptor encephalitis due to HSV-1 infection. 3 However, our case is unique in having a unipolar depressive disorder initially, who went on to develop a bipolar illness after HSV infection-triggered NMDA encephalitis.…”