scholarly journals Differentiation of the first psychotic episode and autoimmune encephalitis with anti-NMDA receptor antibodies, using the EEG findings – case report and literature review

2020 ◽  
Vol 29 (1) ◽  
pp. 67-73
Author(s):  
Adam Hirschfeld ◽  
Daniel Lubiński ◽  
Łukasz Szumerowicz
Keyword(s):  
Case Report ◽  
Nmda Receptor ◽  
Literature Review ◽  
Autoimmune Encephalitis ◽  
Psychotic Episode ◽  
First Psychotic Episode ◽  
Receptor Antibodies

scholarly journals Anti-NMDA-Receptor Encephalitis: Case Report and Literature Review of an Under-Recognized Condition

2011 ◽  
Vol 26 (7) ◽  
pp. 811-816 ◽  
Author(s):  
Gregory S. Day ◽  
Sasha M. High ◽  
Bianca Cot ◽  
David F. Tang-Wai
Keyword(s):  
Case Report ◽  
Nmda Receptor ◽  
Literature Review ◽  
Nmda Receptor Encephalitis

scholarly journals Anti-NMDA Receptor Encephalitis Presenting as an Acute Psychotic Episode in a Young Woman: An Underdiagnosed yet Treatable Disorder

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Shikma Keller ◽  
Pablo Roitman ◽  
Tamir Ben-Hur ◽  
Omer Bonne ◽  
Amit Lotan
Keyword(s):  
Nmda Receptor ◽  
Cognitive Rehabilitation ◽  
Psychiatric Symptoms ◽  
Immunosuppressive Treatment ◽  
Autoimmune Encephalitis ◽  
Memory Deficits ◽  
Ovarian Teratoma ◽  
Psychotic Episode ◽  
Acute Psychosis ◽  
Nmdar Encephalitis

Anti-NMDA receptor (NMDAR) encephalitis is a recently identified autoimmune disorder with prominent psychiatric symptoms. Patients usually present with acute behavioral change, psychosis, catatonic symptoms, memory deficits, seizures, dyskinesias, and autonomic instability. In female patients an ovarian teratoma is often identified. We describe a 32-year-old woman who presented with acute psychosis. Shortly after admission, she developed generalized seizures and deteriorated into a catatonic state. Although ancillary tests including MRI, electroencephalogram, and cerebrospinal fluid (CSF) analysis were unremarkable, the presentation of acute psychosis in combination with recurrent seizures and a relentless course suggested autoimmune encephalitis. The patient underwent pelvic ultrasound which disclosed a dermoid cyst and which led to an urgent cystectomy. Plasmapheresis was then initiated, yielding partial response over the next two weeks. Following the detection of high titers of anti-NMDAR antibodies in the CSF, the patient ultimately received second line immunosuppressive treatment with rituximab. Over several months of cognitive rehabilitation a profound improvement was eventually noted, although minor anterograde memory deficits remained. In this report we call for attention to the inclusion of anti-NMDAR encephalitis in the differential diagnosis of acute psychosis. Prompt diagnosis is critical as early immunotherapy and tumor removal could dramatically affect outcomes.

scholarly journals NMDA-receptor antibodies alter cortical microcircuit dynamics

2017 ◽  
Author(s):  
RE Rosch ◽  
S Wright ◽  
G Cooray ◽  
M Papadopoulou ◽  
S Goyal ◽  
...  
Keyword(s):  
Nmda Receptor ◽  
Mouse Model ◽  
Spectral Composition ◽  
Field Potential ◽  
Autoimmune Encephalitis ◽  
Neuronal Population ◽  
Diverse Range ◽  
Excitatory Neurotransmitter ◽  
Eeg Abnormalities ◽  
Receptor Antibodies

AbstractNMDA-receptor antibodies (NMDAR-Ab) cause an autoimmune encephalitis with a diverse range of electroencephalographic (EEG) abnormalities. NMDAR-Ab are believed to disrupt receptor function, but how blocking this excitatory neurotransmitter can lead to paroxysmal EEG abnormalities – or even seizures – is poorly understood. Here, we show that NMDAR-Ab change intrinsic cortical connections and neuronal population dynamics to alter the spectral composition of spontaneous EEG activity, and predispose to paroxysmal EEG abnormalities. Based on local field potential recordings in a mouse model, we first validate a dynamic causal model of NMDAR-Ab effects on cortical microcircuitry. Using this model, we then identify the key synaptic parameters that best explain EEG paroxysms in paediatric patients with NMDAR-Ab encephalitis. Finally, we use the mouse model to show that NMDAR-Ab- related changes render microcircuitry critically susceptible to overt EEG paroxysms, when these key parameters are changed. These findings offer mechanistic insights into circuit-level dysfunction induced by NMDAR-Ab.

scholarly journals Anti-N-Methyl-D-Aspartate Encephalitis as Paraneoplastic Manifestation of Germ-Cells Tumours: A Cases Report and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Claudia Geraldine Rita ◽  
Israel Nieto Gañan ◽  
Adriano Jimenez Escrig ◽  
Ángela Carrasco Sayalero
Keyword(s):  
Nmda Receptor ◽  
Germ Cell ◽  
Germ Cells ◽  
Germ Cell Tumour ◽  
Clinical Manifestations ◽  
Autoimmune Encephalitis ◽  
Cell Tumour ◽  
Ovarian Teratoma ◽  
Surgical Removal ◽  
Receptor Antibodies

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is the most common form of autoimmune encephalitis, caused by the interaction between an antibody and its target, located on glutamate receptor type N-methyl-D-aspartate (NMDA) of neuronal surface. There is a wide spectrum of clinical features starting by a viral-like prodrome, followed by symptoms such as psychosis, aggressive behaviour, memory loss, seizures, movement disorders, and autonomic instability. Up to 50% of the affected young female patients have germ-cells tumours as ovarian teratoma, making it essential to establish an early diagnosis through detection of specific antibodies in serum and cerebrospinal fluid (CSF). This retrospective observational study was performed in patients whom positive anti-NMDA receptor antibodies have been tested, associated with clinical manifestations that suggest autoimmune encephalitis and a germ-cell tumour confirmed by pathology. Six patients have tested positive for anti-NMDA receptor antibodies associated with a germ-cell tumour and clinical manifestations of autoimmune encephalitis. Management includes aggressive immunosuppression and surgical removal.

The relevance of Paraphrenia: Case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S699-S699
Author(s):  
M. Peixoto ◽  
M.M. Oliveira ◽  
M. Bragança
Keyword(s):  
Case Report ◽  
Psychotic Episode ◽  
Psychiatric Ward ◽  
Cognitive Deterioration ◽  
Medical Work ◽  
First Psychotic Episode ◽  
Not Otherwise Specified ◽  
Personality Changes ◽  
Competing Interest ◽  
Disorganized Speech

IntroductionParaphrenia is a chronic psychotic disorder with a better-preserved affect and minimal disturbances of emotion and volition and a much less cognitive deterioration and personality changes.Objectives/aimsTo report a case with probable Paraphrenia and to highlight the importance of the differential diagnosis in a first psychotic episode.MethodsCase report and systematic review of the literature.ResultsWe report a case of a 41-year-old man without a past psychiatry history that was led to the psychiatry emergency department (PED), by officers, because of strange behaviour and aggressiveness towards his family. In the PED the patient said that his real father was his father-in-law and that his ex-wife was his sister. His mental exam revealed disinhibition, disorganized speech with slightly mood elation, persecutory, mystic and influential delusions with various delusional interpretations. After being admitted to the psychiatric ward, in compulsatory care, he began treatment and a medical work up was completed. According to the family the patient had begun this strange behaviour four years prior. During the hospitalization it became clear that the patient was experiencing imaginative-confabulatoric multi-thematic delusions, sometimes interviewer guided, without showing cognitive deterioration and retaining his personality.ConclusionsThe diagnosis of atypical psychosis or psychosis not otherwise specified is not satisfactory since it agglutinates different conditions together. Paraphrenia is a well-established concept and should be used in order to define a group of psychotic patients who exhibited characteristic symptoms of schizophrenia, minus personality impairment and slower cognitive decline.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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