Seizures due to paraneoplastic anti-n-methyl-d-aspartate reseptor encephalitis associated ovarian teratoma

Abstract

Background Seizures can be a manifestation of paraneoplastic syndrome which are the consequence of an immune reaction to neuronal elements driven by an underlying malignancy affecting organs and tissues. This immune reaction can cause autoimun encephalitis. One of the antibody commonly that be found in paraneoplastic encephalitis is antibody against neurotransmitter N-Metil D-Aspartat (anti- receptor NMDA). The anti-receptor NMDA paraneoplastic encephalitis is also very rare and the incidence is unclear. In Indonesia this case is rarely found due to the unavailability of NMDA anti-receptor examinations in health care centers resulting in late diagnosis or even undiagnosed. Case report 31-year-old woman with complaints of changes in moody behavior, hallucinations, memory disorders, experienced neurological deterioration in the form of decreased consciousness and seizures (status epilepticus). There is no typical neurological deficit. Normal head MRI examination. EEG examination is obtained ;“extreme delta brush;”. Anti NMDAR examination on CSF has positive results. Gynecological obstetric examination is obtained by a cystic mass with a solid part of the right ovary. The results of anatomical pathology examination on post-salpingooforectomy tissue showed mature cystic teratoma. Follow-up management with anticonvulsant and immunotherapy (steroids, intravenous immunoglobulins, plasmaparesis, immunosuppressants) results in good clinical improvement. Conclusion Consider a paraneoplastic autoimmune encephalitis (anti NMDA receptor encephalitis) as the cause of a neuropsychiatric disorder accompanied by seizures being the main focus in this case. A typical EEG picture can help diagnose. Early diagnosis and adequate management will give a good outcome.