2019, Number 4
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Rev Mex Pediatr 2019; 86 (4)
Anti-NMDAR encephalitis: a pediatric case with expressive aphasia
Caycho-Gamarra GA, Quispe-Rivas MC, Carreazo-Pariasca NY, Muñoz-Huerta PR
Language: Spanish
References: 19
Page: 151-154
PDF size: 185.89 Kb.
ABSTRACT
Introduction: Anti-receptor N methyl-D aspartate (anti-NMDA) autoimmune encephalitis is the leading cause of acute autoimmune encephalitis in children and adolescents, with the male group accounting for the highest proportion of cases in children under 12 years of age.
Case presentation: We present the case of a female patient of six years of age, who presented signs and symptoms suggestive of encephalitis, the most outstanding were aphasia of expression, hypotonia, seizures and disautonomy. After ruling out a viral etiology, in cerebrospinal fluid sample was performed for the detection of anti-NMDA autoantibodies, which was positive. After the start of steroid and immunoglobulin treatment, the patient gradually improved.
Conclusions: Autoimmune N-methyl-D aspartate encephalitis should be suspected as part of the differential diagnosis of acute encephalitis. Early treatment is associated with a better prognosis.
REFERENCES
Tunkel A, Glaser C, Bloch K, Seivar J, Marra C, Roos K et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008; 47(3): 303-327.
Granerod J, Crowcroft NS. The epidemiology of acute encephalitis. Neuropsychol. 2007; 17: 406-428.
Leypoldt F, Wandinger K, Bien C, Dalmau J. Autoinmune encephalitis. Eur Neurol Rev. 2013; 8(1): 31-37.
Lancaster E. The diagnosis and treatment of autoimmune encephalitis. J Clin Neurol. 2016; 12(1): 1-13.
Granerod J, Ambrose H, Daves N, Clewley J, Walsh A, Morgan D et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010; 10(12): 835-844.
Gable M, Sheriff H, Dalmau J, Tilley D, Glaser C. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis. 2012; 54(7): 899-904.
Dalmau J, Tüzün E, Wu H, Masjuan J, Rossi J, Voloshin A, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007; 61(1): 25-36.
Dalmau J, Lancaster E, Martinez- Hernandez E, Rosenfeld M, Balice- Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011; 10(1): 63-74.
Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013; 12: 157-165.
Mooneyham G, Gallentine W, Van Hater H. Evaluation and management of autoimmune encephalitis: a clinical overview for the practicing child psychiatrist. Child Adolesc Psychiatr Clin N Am. 2018; 27(1): 37-52.
Lizuka T, Sakai F, Ide T, Monzen T, Yoshii S, Iigaya M, et al. Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal. Neurology. 2008; 70: 504-511.
Sansing LH, Tuzun E, Ko MW, Baccon J, Lynch DR, Dalmau J. A patient with encephalitis associated with NMDA receptor antibodies. Nat Clin Pract Neurol. 2007; 3: 291-296.
Dalmau J, Gleichman AJ, Hughes EG, Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008; 7: 1091-1098.
Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol. 2009; 66: 11-18.
Mann A, Grebenciucova E, Lukas R. Anti-N-methyl-d-aspartate-receptor encephalitis: diagnosis, optimal management, and challenges. Ther Clin Risk Manag. 2014; 10: 517-525.
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.
Pruss H, Dalmau J, Harm L, Höltje M, Ahnert-Hilger G, Borowski K, et al. Retrospective analysis of NMDA receptor antibodies in encephalitis of unknown origin. Neurology. 2010; 75: 1735-1739.
Wandinger K, Saschenbrecker S, Stoecker W, Dalmau J. Anti-NMDA-receptor encephalitis: a severe, multistage, treatable disorder presenting with psychosis. J Neuroimmunol. 2011; 231(1-2): 86-91.
Lancaster E, Martinez-Hernandez E, Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology. 2011; 77(2): 179-189.