Management of neuropsychiatric symptoms in anti NMDAR encephalitis: a case report

Abstract

Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is recognized as the most commonly diagnosed autoimmune encephalitis and is one of the most common causes of encephalitis. A wide spectrum of symptoms such as psychosis, catatonia, behavioral and memory changes, seizures, abnormal movements and autonomic dysregulation usually requires a multidisciplinary treatment approach.Early recognition and prompt initiation of immunotherapy improves patient outcomes.We present a case of a 16-year-old female who had seizures and later had catatonia and psychotic symptoms.Our patient was treated with Rituxumab when he did not get enough benefit from the first-line treatments. Significant improvement in both neurological and psychiatric symptoms occurred after rituxumab treatment.This case highlights the importance of multidisciplinary approach in patients with NMDAR encephalitis and the importance of early transition to second-line treatments in patients who do not respond adequately to first-line treatments. It is aimed to draw attention to the fact that early diagnosis and treatment can dramatically improve neuropsychiatric symptoms, and therefore clinicians should definitely remember NMDAR encephalitis in the differential diagnosis.