Successful treatment of anti-N-methyl-D-aspartate receptor encephalitis presenting with catatonia
- 1Department of Paediatrics, Klinikum Augsburg, Augsburg, Germany
- 2Department of Epileptology, University of Bonn, Bonn, Germany
- 3Neurosciences Group, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Johannes Penzien, Department of Paediatrics, Klinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany;
- Accepted 7 November 2008
The case of a 12-year-old girl with the typical clinical symptoms of the recently described anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is reported. Within 6 weeks the full clinical spectrum of this condition presented with seizures, agitation, stupor, autonomic instability, dysphagia and hypoventilation leading to a diagnosis of pernicious catatonia. MRI and CSF glucose, protein and lactate were repeatedly normal. EEG revealed rhythmical slowing. No teratoma was detected. Recognition of the unique pattern of the clinical symptoms led to early consideration of this disease which was confirmed by detection of anti-NMDAR antibodies. After high dose prednisolone without clinical improvement, plasmapheresis was followed by a rapid reduction in antibodies and recovery within a few weeks. To our knowledge this is the youngest patient with anti-NMDAR encephalitis to have been described to date. We speculate that NMDAR antibodies may be directly involved in the pathogenesis of this disease.
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Competing interests: AV’s department receives royalties and payments for antibody tests.