Severe Cognitive Impairment Associated With Intrathecal Antibodies to the NR1 Subunit of the<i>N</i>-Methyl-D-Aspartate Receptor in a Patient With Multiple Sclerosis

Fleischmann, Robert; Prüß, Harald; Rosche, Berit; Bahnemann, Markus; Gelderblom, Hans; Deuschle, Katrin; Harms, Lutz; Kopp, Ute A.; Ruprecht, Klemens

doi:10.1001/jamaneurol.2014.1817

Cited by 34 publications

(22 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 5 In our case, those antibodies were not found. Of note, NMDAR encephalitis–related symptoms occurred 3 months after the patient gave birth to a healthy child, paralleling a recently described case, 4 although our case showed a less severe disease course.…”

Section: Discussionsupporting

confidence: 89%

“… 1 Autoantibodies against NMDAR are also found in cases of CNS demyelinating diseases such as acute disseminated encephalomyelitis (ADEM), 2 optic neuritis (ON), 2 neuromyelitis optica spectrum disorders (NMOSDs), 3 or multiple sclerosis (MS). 4 Recent data point to a possible association of NMDAR antibodies with demyelination in some patients, particularly when IgG antibodies against glial surface antigens aquaporin-4 (AQP4) or myelin oligodendrocyte glycoprotein (MOG) are present. 5 …”

mentioning

confidence: 99%

See 1 more Smart Citation

NMDA receptor antibodies

Ramberger

Bsteh

Schanda

et al. 2015

Neurol Neuroimmunol Neuroinflamm

View full text Add to dashboard Cite

Objectives:To analyze the frequency of NMDA receptor (NMDAR) antibodies in patients with various inflammatory demyelinating diseases of the CNS and to determine their clinical correlates.Methods:Retrospective case-control study from 2005 to 2014 with the detection of serum IgG antibodies to NMDAR, aquaporin-4, and myelin oligodendrocyte glycoprotein by recombinant live cell-based immunofluorescence assays. Fifty-one patients with acute disseminated encephalomyelitis, 41 with neuromyelitis optica spectrum disorders, 34 with clinically isolated syndrome, and 89 with multiple sclerosis (MS) were included. Due to a known association of NMDAR antibodies with seizures and behavioral symptoms, patients with those clinical manifestations were preferentially included and are therefore overrepresented in our cohort. Nine patients with NMDAR encephalitis, 94 patients with other neurologic diseases, and 48 healthy individuals were used as controls.Results:NMDAR antibodies were found in all 9 patients with NMDAR encephalitis but in only 1 of 215 (0.5%) patients with inflammatory demyelination and in none of the controls. This patient had relapsing-remitting MS with NMDAR antibodies present at disease onset, with an increase in NMDAR antibody titer with the onset of psychiatric symptoms and cognitive deficits.Conclusion:In demyelinating disorders, NMDAR antibodies are uncommon, even in those with symptoms seen in NMDAR encephalitis.

show abstract

Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

NMDA receptor antibodies

Ramberger

Bsteh

Schanda

et al. 2015

Neurol Neuroimmunol Neuroinflamm

View full text Add to dashboard Cite

show abstract

“…Several cases of multiple sclerosis with overlapping NMDA encephalitis have also been reported. [75][76][77][78]…”

Section: Nmdar Encephalitis Overlapping With Demyelinating Diseasementioning

confidence: 99%

An Overview of Autoimmune and Paraneoplastic Encephalitides

Bradshaw

Linnoila

2018

Semin Neurol

View full text Add to dashboard Cite

The understanding of the manifestations, mechanisms, and management of autoimmune encephalitis has expanded dramatically in recent decades. Immune-mediated encephalitides are comparable in incidence and prevalence to infectious etiologies, and are associated with significant morbidity, especially when there is a delay in recognition and treatment. As such, clinicians from many specialties must develop a functional understanding of these disorders. Herein we provide an overview of the autoimmune and paraneoplastic encephalitides, including those associated with either intracellular or cell surface/synaptic neuronal autoantibodies. After briefly reviewing the current understanding of the pathobiology of autoimmune encephalitis, we combine a neuroanatomical approach with specific antibody syndromes to provide the reader with a clinically relevant review of these disorders. The clinical manifestations, diagnosis, and management of autoimmune encephalitis are reviewed, with an emphasis on clinical relevance. We also introduce updates in the field, including autoimmune encephalitis associated with novel cancer immunotherapies, infectious triggers of autoimmune encephalitis, and autoimmune encephalitis with demyelinating overlap syndromes.

show abstract

“…3 We describe two patients with an initial presentation consistent with anti-NMDAR encephalitis who have subsequently developed relapsing-remitting multiple sclerosis (MS). The cases described build on the three existing reports of anti-NMDAR encephalitis occurring in patients with established MS. [4][5][6] These cases outline patients with relapsing-remitting MS who had developed encephalopathy. In two of the previously reported cases, a prompt diagnosis was crucial to commence appropriate immunotherapy and to avoid neuro-psychiatric deficits.…”

Section: Introductionmentioning

confidence: 99%