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2024, Number 5

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Rev Mex Pediatr 2024; 91 (5)

Anti-NMDAr encephalitis

Miguel-Sardaneta ML, Solís-Cordero FD, Ramos-Rojas I, Niño-Barrios D, Domínguez-Arellano G

Language: Spanish
References: 24
Page: 193-197
PDF size: 366.86 Kb.


ABSTRACT

Introduction: anti-N-methyl-D-aspartate receptor (anti-NMDAr) encephalitis is considered a form of autoimmune encephalitis. Its symptoms include neurological, cognitive, motor, and psychiatric disorders. Case description: a seven-year-old female patient, with no personal pathological history, presented with visual hallucinations, sleep and behavioral disorders, and vertigo. Laboratory studies revealed leukocytosis, but no changes in acute-phase reactants; blood and cerebrospinal fluid (CSF) cultures were negative. Magnetic resonance imaging showed paraventricular and frontal cortex hyperintensity. The electroencephalogram showed a "delta brush" pattern, leading to suspicion of autoimmune encephalitis. Anti-NMDAr antibodies in the CSF were positive. Immunoglobulin and methylprednisolone were started, leading to symptom improvement. Conclusions: the diagnosis of anti-NMDAr encephalitis in pediatrics can be a challenge due to neuropsychiatric symptomatology; Its early identification allows targeted treatment.


REFERENCES

  1. Zhao X, Teng Y, Ni J, Li T, Shi J, Wei M. Systematic review: clinical characteristics of anti-N-methyl-D-aspartate receptor encephalitis. Front Hum Neurosci. 2023; 17: 1261638. doi: 10.3389/fnhum.2023.1261638.

  2. Song X, Luo Z, Huang D, Lv J, Xiao L, Liang T et al. Global study of anti-NMDA encephalitis: a bibliometric analysis from 2005 to 2023. Front Neurol. 2024; 15: 1387260. doi: 10.3389/fneur.2024.1387260.

  3. Dalmau J, Armangué T, Planagumà J, Radosevic M, Mannara F, Leypoldt F et al. An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models. Lancet Neurol. 2019; 18(11): 1045-1057. doi: 10.1016/S1474-4422(19)30244-3.

  4. Agarwal R, Gupta V. Anti-NMDAR encephalitis in children. StatPearls, 2023. Available in: https://www.ncbi.nlm.nih.gov/books/NBK562218/

  5. Guanyabens N, Casado V, Giné E, Palomeras E, Muriana D, Boix E et al. Encefalitis antirreceptor de NMDA. Diagnóstico y tratamiento precoz en pacientes con sintomatología psicótica aguda-subaguda. Rev Neurol. 2019; 68: 18-22. doi: https://doi.org/10.33588/rn.6801.2018386

  6. Suarez J, Soto C, Aparicio L, Florentín C, Medina, Vázquez J et al. Encefalitis autoinmune por anticuerpos contra el receptor N-metil-D-aspartato (NMDA): serie de casos en niños. Rev Parag Reumatol. 2022; 8(1): 21-26. doi: https://doi.org/10.18004/rpr/2022.08.01.21

  7. Tanguturi YC, Hanzlik E. Anti-NMDAR encephalitis: multidisciplinary development of a clinical practice guideline. Hosp Pediatr. 2021; 11(11): 1295-1302. Available in: https://doi.org/10.1542/hpeds.2021-005882

  8. Guasp M, Ariño H, Dalmau J. Encefalitis autoinmunes. Revista de Neurología. 2018; 66(2): 1-6. Available in: https://doi.org/10.33588/rn.66S02.2018168

  9. Barter K, Fuchs C, Graham T, Pagano L, Vater M. Anti-NMDAR encephalitis clinical practice guideline: improving time to diagnosis, treatment, and hospital length of stay. Neurology: Clinical Practice. 2023; 14(1): e200218. Available in: https://www.neurology.org/doi/10.1212/CPJ.0000000000200218

  10. Restrepo-Martínez M, Espinola-Nadurille M, López-Hernández JC, Martínez V, Téllez-Martínez JA, Bustamante-Gómez PA, et al. Aspectos neuropsiquiátricos de la encefalitis por anticuerpos contra el receptor NMDA. Rev Alerg Mex. 2021; 68(4): 251-263. Available in: https://doi.org/10.29262/ram.v68i4.953

  11. Gole S, Anand A. Autoimmune encephalitis. StatPearls; 2024. Available in: https://www.ncbi.nlm.nih.gov/books/NBK578203/

  12. Hiesgen J, Schutte C. Autoimmune encephalitis: part 1 (epidemiology, pathophysiology and clinical spectrum). S Afr Med J. 2023; 113(3): 116-121. doi: 10.7196/SAMJ.2023.v113i3.780.

  13. Lee SH, Lee CY, Park HS, Park J, Yun JY. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis associated with mediastinal and ovarian teratomas: a case report. J Korean Med Sci. 2023; 38(6): e31. Available in: https://doi.org/10.3346/jkms.2023.38.e31

  14. Armangue T, Titulaer MJ, Málaga I, Bataller L, Gabilondo I, Graus F et al. Pediatric anti-N-methyl-D-aspartate receptor encephalitis-clinical analysis and novel findings in a series of 20 patients. J Pediatr. 2013; 162(4): 850-856.e2. doi: 10.1016/j.jpeds.2012.10.011.

  15. González-Latapi P, Rodríguez-Violante M, et al. Encefalitis por anticuerpos antirreceptor de N-metil-D aspartato (anti-NMDAR): reporte de un caso. Gac Med Mex. 2014; 150: 348-351. Disponible en: https://www.anmm.org.mx/GMM/2014/n4/GMM_150_2014_4_348-351.pdf

  16. Ariño H, Muñoz-Lopetegi A, Martinez-Hernandez E, Armangue T, Rosa-Justicia M, Escudero D, et al. Sleep disorders in anti-NMDAR encephalitis. Neurology. 2020; 95(6): e671-e684. Available in: https://doi.org/10.1212/wnl.0000000000009987

  17. Ralls F, Cutchen L, Grigg-Damberger MM. Recognizing new-onset sleep disorders in autoimmune encephalitis often prompt earlier diagnosis. J Clin Neurophysiol. 2022; 39(5): 363-371. doi: 10.1097/WNP.0000000000000820.

  18. Nathoo N, Anderson D, Jirsch J. Extreme delta brush in Anti-NMDAR encephalitis correlates with poor functional outcome and death. Front Neurol. 2021; 12: 686521. doi: 10.3389/fneur.2021.686521.

  19. Sankaranarayanan M, Shah S, Thomas P, Kannoth S, Radhakrishnan K. Persistent extreme delta brush in anti-NMDA-receptor encephalitis: does it portend a poor prognosis? Epilepsy Behav Rep. 2019; 12: 100324. doi: 10.1016/j.ebr.2019.100324.

  20. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012; 79(11): 1094-1100. doi: 10.1212/WNL.0b013e3182698cd8.

  21. Abunada M, Nierobisch N, Ludovichetti R, Simmen C, Terziev R, Togni C et al. Autoimmune encephalitis: Early and late findings on serial MR imaging and correlation to treatment timepoints. Eur J Radiol Open. 2024; 12: 100552. doi: 10.1016/j.ejro.2024.100552.

  22. Caycho GA, Quispe M, Carreazo NY, Muñoz PM. Encefalitis anti-NMDAR: un caso pediátrico con afasia de expresión. Rev Mex Pediatr. 2020; 86(4): 151-154. https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0035-00522019000400151

  23. Lee SK, Lee ST. The laboratory diagnosis of autoimmune encephalitis. J Epilepsy Res. 2016; 6(2): 45-50. doi: 10.14581/jer.16010.

  24. Thaler FS, Zimmermann L, Kammermeier S, Strippel C, Ringelstein M, Kraft A et al. Rituximab treatment and long-term outcome of patients with autoimmune encephalitis: real-world evidence from the GENERATE registry. Neurol Neuroimmunol Neuroinflamm. 2021; 8(6): e1088. doi: 10.1212/NXI.0000000000001088.




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