DOI QR코드

DOI QR Code

Childhood Onset of Anti-N-Methyl-D-Aspartate Receptor Encephalitis Without Teratoma Masquerading as a Psychotic Disorder

  • Yeum, Tae-Sung (Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine) ;
  • Lee, Jung (Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine) ;
  • Park, Sung-Yeol (Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine) ;
  • Joen, Yaelim (Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine) ;
  • Kim, Bung-Nyun (Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine)
  • Received : 2018.12.14
  • Accepted : 2019.03.26
  • Published : 2019.07.01

Abstract

Many neurologic disorders manifest as psychiatric symptoms. Anti-N-Methyl-D-Aspartate (NMDA) receptor encephalitis is an autoimmune disease of the brain characterized by numerous neurological and psychiatric features. Despite being rare, its prevalence is rapidly increasing and early management is critical in ensuring successful and sustainable recovery. Therefore, the illness should be considered as a differential diagnosis when clinically assessing patients. This report presents a case of a female child who was hospitalized for acute psychiatric manifestations, which was later confirmed as anti-NMDA receptor encephalitis. She recovered relatively successfully after combined neurological and psychiatric treatment. This report provides information on the clinical course of early onset anti-NMDA receptor encephalitis, including treatment strategy and prognosis.

Keywords

References

  1. Dalmau J, Tuzun E, Wu HY, Masjuan J, Rossi JE, Voloschin A, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 2007;61:25-36. https://doi.org/10.1002/ana.21050
  2. Kayser M, Dalmau J. Anti-NMDA receptor encephalitis in psychiatry. Curr Psychiatry Rev 2011;7:189-193. https://doi.org/10.2174/157340011797183184
  3. 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. https://doi.org/10.1016/S1474-4422(10)70253-2
  4. Irani SR, Bera K, Waters P, Zuliani L, Maxwell S, Zandi MS, et al. N-methyl-D-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly nonparaneoplastic disorder of both sexes. Brain 2010;133:1655-1667. https://doi.org/10.1093/brain/awq113
  5. Shin MS, Cho S, Chun SY, Hong KE. A study of the development and standardization of ADHD diagnostic system. J Korean Acad Child Adolesc Psychiatry 2000;11:91-99.
  6. Armangue T, Titulaer MJ, Malaga I, Bataller L, Gabilondo I, Graus F, et al. Pediatric anti-N-methyl-D-aspartate receptor encephalitisclinical analysis and novel findings in a series of 20 patients. J Pediatr 2013;162:850-856.e2. https://doi.org/10.1016/j.jpeds.2012.10.011
  7. Kayser MS, Titulaer MJ, Gresa-Arribas N, Dalmau J. Frequency and characteristics of isolated psychiatric episodes in anti-N-methyl-d-aspartate receptor encephalitis. JAMA Neurol 2013;70:1133-1139. https://doi.org/10.1001/jamaneurol.2013.3216
  8. Titulaer MJ. Anti-NMDA receptor encephalitis mimicking schizophrenia: diagnosis and treatment. Eur Neuropsychopharmacol 2016;2:S134-S135.
  9. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008;7:1091-1098. https://doi.org/10.1016/S1474-4422(08)70224-2
  10. Gresa-Arribas N, Titulaer MJ, Torrents A, Aguilar E, McCracken L, Leypoldt F, et al. Diagnosis and significance of antibody titers in anti-NMDA receptor encephalitis, a retrospective study. Lancet Neurol 2014;13:167-177. https://doi.org/10.1016/S1474-4422(13)70282-5
  11. Nosadini M, Boniver C, Zuliani L, De Palma L, Cainelli E, Battistella PA, et al. Longitudinal electroencephalographic (EEG) findings in pediatric anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis: the Padua experience. J Child Neurol 2015;30:238-245. https://doi.org/10.1177/0883073813515947
  12. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology 2012;79:1094-1100. https://doi.org/10.1212/WNL.0b013e3182698cd8
  13. Gable MS, Sheriff H, Dalmau J, Tilley DH, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis 2012;54:899-904. https://doi.org/10.1093/cid/cir1038
  14. Chapman MR, Vause HE. Anti-NMDA receptor encephalitis: diagnosis, psychiatric presentation, and treatment. Am J Psychiatry 2011;168:245-251. https://doi.org/10.1176/appi.ajp.2010.10020181
  15. 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;71:1921-1923. https://doi.org/10.1212/01.wnl.0000336648.43562.59
  16. Houtrow AJ, Bhandal M, Pratini NR, Davidson L, Neufeld JA. The rehabilitation of children with anti-N-methyl-D-aspartate-receptor encephalitis: a case series. Am J Phys Med Rehabil 2012;91:435-441. https://doi.org/10.1097/PHM.0b013e3182465da6
  17. Reid DK, Clardy SL. Anti-NMDA-receptor encephalitis: unusual presentation of an uncommon condition. J Neurol Neurosurg Psychiatry 2013;84:69-70. https://doi.org/10.1136/jnnp-2012-302904
  18. Hughes EG, Peng X, Gleichman AJ, Lai M, Zhou L, Tsou R, et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci 2010;30:5866-5875. https://doi.org/10.1523/JNEUROSCI.0167-10.2010
  19. Hinkle CD, Porter JN, Waldron EJ, Klein H, Tranel D, Heffelfinger A. Neuropsychological characterization of three adolescent females with anti-NMDA receptor encephalitis in the acute, post-acute, and chronic phases: an inter-institutional case series. Clin Neuropsychol 2017;31:268-288. https://doi.org/10.1080/13854046.2016.1191676
  20. Finke C, Kopp UA, Pruss H, Dalmau J, Wandinger KP, Ploner CJ. Cognitive deficits following anti-NMDA receptor encephalitis. J Neurol Neurosurg Psychiatry 2012;83:195-198. https://doi.org/10.1136/jnnp-2011-300411