Abstract
N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune neurological disorder arising from the generation of antibodies which binds to the synaptic proteins. Here we present a case series of 3 cases where the different aspects of treating NMDAR encephalitis are dealt with. The association of ovarian teratoma and the importance of its removal before treating the encephalitis have been discussed in the second case. Apart from the first line and second line agents used in the therapy of NMDAR encephalitis, the importance of managing infections especially urinary tract infection and lower respiratory tract infection with antibiotics have also been discussed. The article also aims to throw light into the treatment of extrapyramidal side effects induced by antipsychotics. At the end, the significance of putting the patient on a ketogenic diet to manage refractory seizures associated with anti-NMDA receptor encephalitis has also been discussed based on reviewing literature.
Highlights
N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune neurological disorder arising from the generation of antibodies which binds to the synaptic proteins
Second line agents like rituximab, a B-cell depleting monoclonal antibody, and/or cyclophosphamide, an alkylating agent, should be used in case the patient is not responding to first-line agents
The results showed NMDA type of glutamate receptor antibody positive in cerebrospinal fluid (CSF) and negative in serum
Summary
N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune neurological disorder arising from the generation of antibodies which binds to the synaptic proteins. Neuroimmunology results showed CSF NMDA type of glutamate receptor antibody and serum NMDA antibody positive but negative for leucine-rich glioma inactivated 1 (LGi-1) antibodies, voltagegated potassium channel (VGKC) antibodies and contactinassociated protein-like 2 (CASPR2) antibodies by immunofluorescence on transfected cells She was diagnosed with anti NMDAR encephalitis in march 2016 and was given first cycle IV Ig (60g) and inj. We took up the case when the child was admitted in Dec 2014 during which she presented with intermittent fever of two weeks duration She was on the following drugs when she was admitted: tab pacitane (trihexyphenidyl) 2 mg 1⁄2-0-1, tab clonazepam 0.25 mg 1-0-1, syp levipil (levetiracetam) (100 mg/ml) 5 ml b. As she continued to have high-grade fever spikes and bronchoalveolar lavage cultures showed growth of Pseudomonas, IV piptaz (piperacillin/tazobactam) was changed to inj meropenem and colistin nebulisation as per the culture sensitivity report
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