Title: Clinical Profile and Long Term Outcome of NMDA Receptor Encephalitis- A Tertiary Care Centre Experience
Authors: Dr Dileep.R, Dr Benjamin Ramacha, Dr Praveen Panicker, Dr Thomas Iype
DOI: https://dx.doi.org/10.18535/jmscr/v6i11.145
Abstract
Introduction: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune encephalitis which predominantly affects children and young adults especially females.
Aim: To study the clinical profile and long term outcome of the patients with Anti NMDA receptor antibody positive encephalitis and assess their response to treatment.
Materials and Methods: Patients admitted in our ward or ICU satisfying the criteria of possible autoimmune encephalitis with a cerebrospinal fluid NMDA Positivity were included. Data including the clinical features, cerebrospinal fluid findings, MRI brain findings, electroencephalography findings and treatment received was noted. All the patients had undergone screening for tumours especially ovarian teratoma. [USG/CT ABDOMEN/MRI ABDOMEN] .Follow up was done at six months and improvement was assessed at follow up.
Results: Mean age of our patients was 16 years and 91.7% of patients were females. Most common symptoms were behaviour changes and seizures.50 percentage of our patients went to a psychiatrist for initial consultation. CSF pleocytosis was seen in 83% of patients. MRI Brain was normal in 58 % of patients. EEG slowing was seen in all patients. We could detect ovarian teratoma in 27.3% of female patients. Only two patients improved with steroids alone. Rest other patients required second line immunotherapy and rituximab. Majority of patients in our study improved without much sequel.
Conclusion: So a young female with new onset of behavioural symptoms, possibility of Autoimmune encephalitis should always be considered and investigated. Early identification and early initiation of treatment shows better response
Keyword: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis
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