Anti-N-Methyl D-Aspartate Receptor (NMDAR) Encephalitis is a rare immune related encephalitis. The definitive diagnosis of the disease would be detection of Anti NMDAR autoantibodies in CSF fluid. The treatment are usually consist of corticosteroids, IVIG or plasma exchange. However, our patient required alternative therapy of Cyclophosphomide due to slow response to first line treatment. She was able to achieve full recovery with no relapse on 1 year follow up. We would like to share our experience of treating Anti-NMDAR Encephalitis by using Cyclophosphamide as an alternative when the first line therapy has failed. More data will be required in the future to develop an updated guideline to treat this rare disease. 

Keywords- Anti-NMDAR encephalitis, cyclophosphomide, Oro-Facial dyskinesia, psychosis, seizures.

1. Pollak A. , Mc CormackR et al. Prevalence of anti-N-methyl-d-aspartate (NMDA) receptor antibodies in patients with schizophrenia and related psychoses: a systematic review and meta-analysis. Psychological Medicine 2014; 44(12): 24752487.
2. Gregory S. Day, Sasha M. High, Bianca Cot, David F. Tang-Wai. Anti-NMDA-Receptor Encephalitis: Case Report and Literature Review of an Under-Recognized Condition. J Gen Internal Medicine. 2011; 26(7):811-816.
3. Suhailah Abdullah, Shen-Yang Lim, Khean Jin Goh, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis: A series of ten cases from a university hospital in Malaysia. Neurology Asia 2011;16(3):241-6
4. Rosenfeld M, Dalmau J. Anti-NMDA-Ecenphalitis and other synaptic autoimmune disorders. Current Treatment Options in Neurology. 2011; 13(3):324-332.
5. Titulaer MJ, McCracken L et al. Treatment and prognostic factors for long term outcome in patients with anti-NMDA encephalitis: an observational cohort study. Lancet Neurology. 2013;12(2):157-165.
6. Galbilondo I, Saiz A, Galan L et al. Analysis of relapses in anti-NMDAR encephalitis. Neurology Aug 2011 DOI:10.1212/WNL.0b013e31822cfc6b

Dr Ka Kiat Chin

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.