A CASE SERIES ON ANTI NMDAR ENCEPHALITIS
N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune neurological disorder arising from the generation of antibodies which binds to the synaptic proteins. Here we present a case series of 3 cases where the different aspects of treating NMDAR encephalitis are dealt with. The association of ovarian teratoma and the importance of its removal before treating the encephalitis have been discussed in the second case. Apart from the first line and second line agents used in the therapy of NMDAR encephalitis, the importance of managing infections especially urinary tract infection and lower respiratory tract infection with antibiotics have also been discussed. The article also aims to throw light into the treatment of extrapyramidal side effects induced by antipsychotics. At the end, the significance of putting the patient on a ketogenic diet to manage refractory seizures associated with anti-NMDA receptor encephalitis has also been discussed based on reviewing literature.
2. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011;10:63-74.
3. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008;7:1091-8.
4. Padma S, Sundaram PS, Marmattom BV. PET/CT in the evaluation of anti-NMDA-receptor encephalitis: what we need to know as a NM physician. Indian J Nucl Med 2011;26:99-101.
5. Armangue T, Titulaer MJ, Malaga I, Bataller L, Gabilondo I, Graus F, et al. Pediatric anti NMDAR encephalitis: clinical analysis and novel findings in a series of 20 patients. J Pediatr 2013;162:850-6.
6. Ishiura H, Matsuda S, Higashihara M, Hasegawa M, Hida A, Hanajima R, et al. Response of anti-NMDA receptor encephalitis without tumor to immunotherapy including rituximab. Neurology 2008;71:1921-6.
7. Dalmau J, Lancaster E, Martinez-Hernandez E. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011;10:63-74.
8. Jankovic J. Tardive syndromes and other drug-induced movement disorders. Clin Neuropharmacol 1955;3:197â€“214.
9. Syed Amer, Parth Shah, Vishnu Kommineni. Refractory status epilepticus from NMDA receptor encephalitis successfully treated with an adjunctive ketogenic diet. Ann Indian Acad Neurol 2015;18 Suppl 2:256â€“7.
10. Kang HC, Chung DE, Kim DW, Kim HD. Early-and late-onset complications of the ketogenic diet for intractable epilepsy. Epilepsia 2004;45:1116â€“23.