Delayed N-methyl-D-aspartate Receptor Encephalitis Relapse

Comparison of childhood (presumed autoimmune encephalitis) and adult presentation (definite NMDA-R encephalitis) clinical and laboratory features Finding Childhood presentation (Age 15) Adulthood presentation (Age 36) Abnormal behaviour/cognitive dysfunction ✓ ✓ Speech dysfunction/mutism ✓ ✓ Seizures ✓ X Movement disorder/abnormal postures ✓ ✓ Decreased level of consciousness ✓ ✓ Autonomic dysfunction Information unavailable ✓ Abnormal EEG ✓ ✓ CSF abnormalities ✓ ✓ NMDA receptor antibody Not performed Strongly positive NMDA receptor encephalitis is an immune-mediated neurological syndrome presenting with personality change, memory loss and behavioural abnormalities, often progressing to psychosis, seizures, movement disorders, autonomic dysfunction, hypoventilation and coma.1 An underlying neoplasm is detected in approximately 40–60% of patients, the majority of which are ovarian teratomas; the remainder of cases are presumed to be autoimmune.1–3 Autoimmune causes of encephalitis are common and early identification of a compatible syndrome, exclusion of infectious causes and application of appropriate immune therapy can significantly improve survival and outcome in these patients. [...]NMDA receptor encephalitis is a treatable condition if recognised early. Treatment and prognostic factors for long-term outcome in patients with anti-N-Methyl-D-Aspartate (NMDA) receptor encephalitis: a cohort study.