levetiracetam and Anti-N-Methyl-D-Aspartate-Receptor-Encephalitis

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder mediated by NMDAR antibodies, typically manifesting as behavioral complaints, psychosis, seizures, movement disorders, hypoventilation, and autonomic dysfunction. In recent years, the predisposing factors and pathophysiological mechanisms of anti-NMDAR encephalitis have been tried to be clarified. It has been recognized that an overlap may be observed between anti-NMDAR encephalitis and inflammatory demyelinating disease. However, anti-NMDAR encephalitis is rarely associated with multiple sclerosis. Here, we describe a Chinese female patient diagnosed with relapsing remitting multiple sclerosis who developed anti-NMDAR encephalitis. Further, we discuss the previously reported literature.

Topics: Adult; Anti-Inflammatory Agents; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Anticonvulsants; Antipsychotic Agents; Female; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Levetiracetam; Methylprednisolone; Multiple Sclerosis, Relapsing-Remitting; Olanzapine; Prednisolone

Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a devastating disease, that despite being increasingly diagnosed, there are no consensus guidelines for the optimal management. A previously healthy 3-year-old-boy brought to the emergency department due to seizures. Neurological examination was normal, and electroencephalogram (EEG) suggested focal epilepsy. Anticonvulsive medication was initiated. He progressively lost age-appropriate language skills, presented behavioural changes and psychiatric symptoms. Neurological examination at that time revealed symmetric gross motor weakness of the lower limbs. Brain and spinal cord MRI and cerebrospinal fluid were normal. Repeated EEG showed global lentification. Steroid therapy was initiated for the suspicion of autoimmune encephalitis, later confirmed as NMDAR encephalitis. He became clinically improved after 10 days of treatment but only returned to his baseline after 3 months of disease onset. The authors emphasised the variable course of the disease and possible late response to treatment.

Topics: Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Anticonvulsants; Child, Preschool; Disease Progression; Glucocorticoids; Humans; Levetiracetam; Male; Methylprednisolone; Seizures

Anti-N-methyl-D-aspartate receptor encephalitis is an autoimmune syndrome that presents with personality changes, autonomic dysfunction, and neurologic deterioration. Most patients with this syndrome progress from psychosis to seizure to catatonia, often associated with abnormal movements, autonomic instability, and hypoventilation. First-line treatment constitutes resection of the associated neoplasm, corticosteroids, intravenous immunoglobulin, and plasma exchange. Second-line treatment includes rituximab and cyclophosphamide. A case of confirmed anti-N-methyl-D-aspartate receptor encephalitis is presented that illustrates the diagnostic and treatment challenges associated with this syndrome and underscores the nursing implications of medical management during immunosuppression. This case study recommends surface cooling and a pharmaceutical regimen for management of autonomic storming, which is a hallmark of this disorder.

Topics: Adult; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Anticonvulsants; Cyclophosphamide; Fatal Outcome; Female; Headache; Humans; Immunologic Factors; Immunosuppressive Agents; Levetiracetam; Ovarian Neoplasms; Piracetam; Rituximab; Seizures