Non-tumor-Associated Anti-<i>N</i>-Methyl-<scp>d</scp>-Aspartate (NMDA) Receptor Encephalitis in Chinese Girls With Positive Anti-thyroid Antibodies

Guan, Wenjuan; Fu, Zhenqiang; Zhang, Hui; Jing, Lijun; Lu, Jingjing; Zhang, Jing; Lü, Hong; Teng, Junfang; Jia, Yanjie

doi:10.1177/0883073815575365

Cited by 16 publications

(17 citation statements)

References 21 publications

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“…To best define the use of first- and second-line therapies, we next examined the reports that provided delineation between initiations of specific therapies. In 15 reports of 20 patients that defined a time period before first agent and initiation of second agent, 13 patients received high corticosteroids administered on mean day 8.71 (SD ± 3.2) and 7 patients received IVIG on mean day 7.57 (SD ± 7.7) ( 19 , 21 , 25 , 27 – 30 , 32 , 36 , 37 , 41 , 42 , 49 , 50 , 58 ). The mean time course from reported first agent to second in these 15 reports was 11.4 days (SD ± 15.6).…”

Section: Resultsmentioning

confidence: 99%

Pediatric Anti-N-Methyl-d-Aspartate Receptor Encephalitis: A Review with Pooled Analysis and Critical Care Emphasis

et al. 2017

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PurposeAnti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is being recognized with increasing frequency among children. Given the paucity of evidence to guide the critical care management of these complex patients, we provide a comprehensive review of the literature with pooled analysis of published case reports and case series.MethodsWe performed a comprehensive literature search using PubMed, Scopus, EMBASE, and Web of Science for relevant published studies. The literature search was conducted using the terms NMDA, anti-NMDA, Anti-N-methyl-d-aspartate, pediatric encephalitis, and anti-NMDAR and included articles published between 2005 and May 1, 2016.ResultsForty-eight references met inclusion criteria accounting for 373 cases. For first-line treatments, 335 (89.8%) received high-dose corticosteroids, 296 received intravenous immunoglobulin (79.3%), and 116 (31%) received therapeutic plasma exchange. In these, 187 children (50.1%) had a full recovery with only minor deficits, 174 patients (46.7%) had partial recovery with major deficits, and 12 children died. In addition, 14 patients were reported to require mechanical ventilation.ConclusionAnti-NMDA encephalitis is a formidable disease with great variation in clinical presentation and response to treatment. With early recognition of this second most common cause of pediatric encephalitis, a multidisciplinary approach by physicians may provide earlier access to first- and second-line therapies. Future studies are needed to examine the efficacy of these current therapeutic strategies on long-term morbidity.

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Section: Resultsmentioning

confidence: 99%

Pediatric Anti-N-Methyl-d-Aspartate Receptor Encephalitis: A Review with Pooled Analysis and Critical Care Emphasis

et al. 2017

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“…Anti-NMDAR encephalitis may also develop with autoimmune disorders, such as autoimmune thyroid diseases, systemic lupus erythematosus, acute disseminated encephalomyelitis, and NMOSD [5,19,20]. HE is an autoimmune encephalopathy which is characterized by high titers of anti-thyroid antibodies [21].…”

Section: Discussionmentioning

confidence: 99%

“…Autoantibodies that are indicative of systemic immune disorders, such as antinuclear antibodies, have also been detected in patients with autoimmune encephalitis, but the literature in this regard is limited [4,5]. Thyroid dysfunction was known as an unfavorable factor for cerebrovascular diseases [6].…”

Section: Introductionmentioning

confidence: 99%

Thyroid Function and Autoimmune Indications in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Ma¹,

Yin²,

Zeng³

et al. 2018

Neuroimmunomodulation

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Objective: Previous studies have shown that functional abnormalities of the thyroid are associated with the pathogenesis of several neurological diseases. However, their relationship in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis remains to be defined. Methods: Forty-three patients with anti-NMDAR encephalitis were examined for thyroid function and autoimmune indications, in comparison with 225 healthy controls (CTL). Patients were further classified into 2 subgroups based on their free tri-iodothyronine (fT3) levels. Moreover, fT3 levels were also investigated after at least three months of follow-up. The clinical characteristics of the patients and CTL were described in detail. Results: Serum levels of fT3 and thyroid-stimulating hormone (TSH) were found to be relatively lower in patients with anti-NMDAR encephalitis than in CTL (both p < 0.001). Low T3 syndrome also occurred more frequently in anti- NMDAR encephalitis (25.6 vs. 0.4%, p < 0.001). However, no statistical differences were detected between patients and CTL in terms of the positive rate of thyroid antibodies and other types of thyroid dysfunction. Patients with low T3 levels tended to have a longer hospital stay (p = 0.006), a higher rate of abnormal brain magnetic resonance imaging (MRI) findings (p = 0.033), a higher frequency of consciousness declination (p = 0.029), and a higher modified Rankin scale (mRS) score during hospitalization. Low fT3 levels were also associated with abnormal MRI findings, a decline in consciousness, and the mRS score on admission. In addition, fT3 seemed to gradually return to normal levels upon improvement of the mRS score (r = –0.649, p = 0.002). Conclusions: Low T3 syndrome often copresents in anti-NMDAR encephalitis and indicates a longer hospitalization, abnormal MRI findings, consciousness declination, and a higher clinical severity. However, fT3 levels do not seem to influence the prognosis of anti-NMDAR encephalitis.

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“…5 She was initially diagnosed with HE which is comparable to our case as HE can present with neurocognitive changes, seizures, and psychiatric symptoms. 4 However, due to lack of response to corticosteroid, another possible cause of the encephalopathy was considered and tests for antibodies to the NMDAR were found positive. The main difference in our case was the age group and the symptomatology.…”

Section: Discussionmentioning

confidence: 99%

“…Lately, several cases have highlighted the coexistence of anti-thyroid antibodies with anti-NMDAR antibodies in non-paraneoplastic anti-NMDAR encephalitis. 4 A PubMed search for “((Anti-N-methyl-d-aspartate) OR NMDA) AND thyroid” (on 13 March 2020) identified 69 items addressing this issue, including 14 case reports. Out of these, 10 are positive for thyroid autoantibodies including one case report in 2016 highlighting subclinical hypothyroidism in an elderly lady presenting with cognitive dysfunction in context of overlap syndrome (anti-NMDAR encephalitis with positive thyroid autoantibodies).…”

Section: Introductionmentioning

confidence: 99%

Anti-N-methyl-D-aspartate receptor encephalitis in a young female with subclinical hypothyroidism associated with anti-thyroid peroxidase and anti-thyroglobulin antibodies: A case report

Khoodoruth

Alshawwaf

2020

SAGE Open Medical Case Reports

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Anti- N-methyl-D-aspartate receptor encephalitis is a life-threatening medical emergency that can be clinically misperceived as Hashimoto’s encephalopathy. We present a case of anti- N-methyl-D-aspartate receptor encephalitis in an otherwise healthy young female with subclinical hypothyroidism without an associated ovarian teratoma. She was first misdiagnosed as Hashimoto’s encephalopathy due to delirium and behavioral changes, seizures, psychosis, and increased amount of thyroid peroxidase and thyroglobulin antibodies in serum. Final diagnosis was established by third week following presentation with the detection of anti- N-methyl-D-aspartate receptor antibodies in her cerebrospinal fluid. After treatment with intravenous immunoglobulin, methylprednisolone, and amisulpride, she recovered significantly with minimal sequelae at 3-week follow-up.

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Non-tumor-Associated Anti-N-Methyl-d-Aspartate (NMDA) Receptor Encephalitis in Chinese Girls With Positive Anti-thyroid Antibodies

Cited by 16 publications

References 21 publications

Pediatric Anti-N-Methyl-d-Aspartate Receptor Encephalitis: A Review with Pooled Analysis and Critical Care Emphasis

Pediatric Anti-N-Methyl-d-Aspartate Receptor Encephalitis: A Review with Pooled Analysis and Critical Care Emphasis

Thyroid Function and Autoimmune Indications in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Anti-N-methyl-D-aspartate receptor encephalitis in a young female with subclinical hypothyroidism associated with anti-thyroid peroxidase and anti-thyroglobulin antibodies: A case report

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