olanzapine 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

Topics: Adolescent; Animals; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Antipsychotic Agents; Autoantibodies; Benzodiazepines; Cerebrospinal Fluid; Delirium; Female; Humans; Length of Stay; Olanzapine; Patient Transfer; Receptors, N-Methyl-D-Aspartate

A 17-year-old man with no significant medical history presented with new-onset seizure activity and altered mental status manifesting as bizarre behaviour, which included rapid pressured and tangential speech, psychomotor agitation, insomnia and delusions. He also had autonomic dysregulation, manifested in labile blood pressures. He had been recently discharged from his first psychiatric hospitalisation. Many studies were performed, including electroencephalogram (EEG), head CT, laboratory work, urine drug screen and lumbar puncture with cerebral spinal fluid studies, which ultimately led to the diagnosis of anti-N-methyl-D-aspartate receptor (NMDAR) autoimmune encephalitis. He was treated with five rounds of plasmapheresis with complete resolution of his altered mental status. This case highlights the importance of being familiar with the presentation of anti-NMDAR autoimmune encephalitis, especially in cases of new-onset mental status changes with psychotic like symptoms, seizure-like activity and autonomic dysregulation as early detection and treatment improves chances of good prognosis with return to baseline cognitive function.

Topics: Adolescent; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Antipsychotic Agents; Autoantibodies; Diagnosis, Differential; Humans; Male; Olanzapine; Plasmapheresis; Psychomotor Agitation

Topics: Adult; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Antipsychotic Agents; Catatonia; Diagnosis, Differential; Female; Humans; Methylprednisolone; Olanzapine; Plasmapheresis; Psychotic Disorders

Topics: Adolescent; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Antipsychotic Agents; Autoantibodies; Clonazepam; Diagnosis, Differential; Female; Humans; Olanzapine; Psychotic Disorders; Receptors, N-Methyl-D-Aspartate

A 19-year-old male came to the Emergency Room of our hospital due to an episode of dystonic movements and disorientation 4 days after consuming methamphetamine, which evolved to a catatonic frank syndrome and eventually to status epilepticus. Definitive diagnosis was anti-NMDA receptor encephalitis, an acute inflammation of the limbic area of autoimmune origin in which early diagnosis and treatment are key elements for the final outcome. In this case, initial normal tests and previous methamphetamine poisoning delayed diagnosis, because inhaled-methamphetamine poisoning causes similar clinical symptoms to anti-NMDA receptor encephalitis. Methamphetamine poisoning may have caused an immune response in the patient, bringing on the progress of the pathology.

Topics: Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Anticonvulsants; Autoantibodies; Benzodiazepines; Catatonia; Delayed Diagnosis; Diagnosis, Differential; Diagnostic Errors; Diazepam; Electroconvulsive Therapy; Emergencies; Epilepsies, Partial; Hallucinations; Humans; Infectious Encephalitis; Male; Methamphetamine; Olanzapine; Poisoning; Receptors, N-Methyl-D-Aspartate; Status Epilepticus; Young Adult

Topics: Acute Disease; Adolescent; Adrenal Cortex Hormones; Adult; Anti-Anxiety Agents; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Antipsychotic Agents; Benzodiazepines; Cognitive Dysfunction; Diagnosis, Differential; Humans; Immunoglobulins; Lorazepam; Male; Mental Disorders; Olanzapine; Treatment Outcome; Young Adult