SEIZURE CONTROL IN PATIENTS WITH ANTI-NMDAR ENCEPHALITIS : CASE SERIES

Abstract

<p><strong>Background: </strong>Anti N-methyl-D-aspartate Receptor (anti-NMDAR) encephalitis is a rare, yet has had increasing number of cases. Patients often require airway protection, mechanical ventilation and intensive care because the patients’ complex symptoms accompanied by seizures that are difficult to control. Here, we present two related case reports that discuss intensive care management and focus on the administered sedation/anesthesia methods and their outcomes.</p><p><strong>Case illustration: </strong>Male patients, 19 and 21 years old, presented with neuropsychiatric symptoms, seizures, dyskinesia. Both require airway protection and mechanical ventilation as well as Intensive Care Unit (ICU) care. Radiodiagnostic head Computed Tomography (CT) scan and head Magnetic Resonance Imagng (MRI) showed no cerebral abnormalities. Cerebrospinal Fluid (CSF) examination showed positive NMDAR antibodies. First patient had failed to improve clinically even with multiple anti-convulsants, ketamine, dexmedetomidine, immunotherapy, and chemotherapy. Second patient clinically improved with benzodiazepine (midazolam) and propofol as anti-convulsants followed by plasma exchange immunotherapy. The two cases had different outcomes. The first case deceased from septic shock, while the second case was treated by outpatient procedure.</p><strong>Conclusion : </strong>Our presented cases suggest that midazolam, propofol, dextemedetomidine, ketamine do not provide satisfying results for seizure control in patients with anti-NMDAR encephalitis, unless immunotherapy is carried out as early as possible and optimally.<strong><em></em></strong><strong></strong><p><strong> </strong></p><p><strong> </strong></p>