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A 16-year-old girl with anti-NMDA-receptor encephalitis and family history of psychotic disorders

Published online by Cambridge University Press:  01 June 2015

Neil Cleland ,
Samuel Lieblich ,
Martin Schalling  and
Christoffer Rahm
Neil Cleland
Affiliation:
Child and Adolescent Psychiatric Clinic, Stockholm County Council, Stockholm, Sweden
Samuel Lieblich
Affiliation:
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
Martin Schalling
Affiliation:
Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
Christoffer Rahm*
Affiliation:
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
*
Dr. Christoffer Rahm, Department of Psychiatry, Melbourne Neuropsychiatry Centre, Alan Gilbert Building, Level 3, 161 Barry Street, Carlton South, 3053 VIC, Australia. Tel: 61 3 9035 8628; Fax: 61 3 9348 0469 E-mail: [email protected]
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Abstract

Background

Autoimmune NMDA-R encephalitis (ANRE) shares clinical features with schizophrenia. Recent research also indicates that both disorders are associated with dysfunction of the N-Methyl-D-Aspartate glutamate receptors (NMDA-R) subunit 1.

Methods

We present the case of Ms A, 16 years old. Ms A presented with acute personality change, bizarre behaviour, delusional ideas and atypical seizures. She had a family history of psychotic disorders, and autistic traits diagnosed in childhood. She was initially diagnosed with a psychotic disorder. Delayed testing of CSF indicated ANRE. As the patient was a Jehovah's witness the treating team was unable to use gammaglobulin therapy; they instead relied on combined plasmapheresis and rituximab. To exclude the possibility that the affected members of this family shared a gene coding for an abnormal configuration of the NMDA receptor subunit 1 we sequenced the region of the GRIN1 gene in DNA extracted from blood in both Ms A and her grandmother.

Results

Ms A’s condition improved dramatically, though her long-term memory is still demonstrably impaired. No genetic abnormality was detected.

Conclusions

This case emphasizes how important it is, for a first episode psychosis, to exclude ANRE and other autoimmune synaptic encephalitides, even in the face of significant family history, and if seronegative, the importance of testing for CSF autoantibodies.

Keywords

encephalitisGRIN1mabtheraN-Methyl-d-aspartic acidpsychosis
Type
Case Report
Information
Acta Neuropsychiatrica , Volume 27 , Supplement 6 , December 2015 , pp. 375 - 379
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Copyright
© Scandinavian College of Neuropsychopharmacology 2015 

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References

1. Hughes, EG, Peng, X, Gleichman, AJ et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci 2010;30:5866–5875.CrossRefGoogle ScholarPubMed
2. Weickert, CS, Fung, SJ, Catts, VS et al. Molecular evidence of N-methyl-D-aspartate receptor hypofunction in schizophrenia. Mol Psychiatry 2013;18:1185–1192.CrossRefGoogle ScholarPubMed
3. Dalmau, J, Lancaster, E, Martinez-Hernandez, E, Rosenfeld, MR, Balice-Gordon, R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011;10:63–74.CrossRefGoogle ScholarPubMed
4. Titulaer, MJ, McCracken, L, Gabilondo, I et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013;12:157–165.CrossRefGoogle ScholarPubMed
5. Maggina, P, Mavrikou, M, Karagianni, S et al. Anti-N-methyl-D-aspartate receptor encephalitis presenting with acute psychosis in a preteenage girl: a case report. J Med Case Rep 2012;6:224.CrossRefGoogle Scholar
6. Kuo, YL, Tsai, HF, Lai, MC, Lin, CH, Yang, YK. Anti-NMDA receptor encephalitis with the initial presentation of psychotic mania. J Clin Neurosci 2012;19:896–898.CrossRefGoogle ScholarPubMed
7. Pruss, H, Holtje, M, Maier, N et al. IgA NMDA receptor antibodies are markers of synaptic immunity in slow cognitive impairment. Neurology 2012;78:1743–1753.CrossRefGoogle ScholarPubMed
8. Steiner, J, Walter, M, Glanz, W et al. Increased prevalence of diverse N-methyl-D-aspartate glutamate receptor antibodies in patients with an initial diagnosis of schizophrenia: specific relevance of IgG NR1a antibodies for distinction from N-methyl-D-aspartate glutamate receptor encephalitis. JAMA Psychiatry 2013;70:271–278.CrossRefGoogle ScholarPubMed
9. Tsutsui, K, Kanbayashi, T, Tanaka, K et al. Anti-NMDA-receptor antibody detected in encephalitis, schizophrenia, and narcolepsy with psychotic features. BMC Psychiatry 2012;12:37.CrossRefGoogle ScholarPubMed
10. Fang-Chun Chen, MDM, Dalmau, J. Case report of persistent anti-NMDAR antibodies 10 years from initial undiagnosed presentation. Neurology 2014;82(Suppl. P3):320.CrossRefGoogle Scholar
11. Kayser, MS, Dalmau, J. Anti-NMDA receptor encephalitis in psychiatry. Curr Psychiatry Rev 2011;7:189–193.CrossRefGoogle ScholarPubMed
12. Pollak, TA, McCormack, R, Peakman, M, Nicholson, TR, David, AS. Prevalence of anti-N-methyl-D-aspartate (NMDA) receptor antibodies in patients with schizophrenia and related psychoses: a systematic review and meta-analysis. Psychol Med 2014;44:2475–2487.CrossRefGoogle ScholarPubMed
13. Diamond, B, Bloom, O, Al Abed, Y, Kowal, C, Huerta, PT, Volpe, BT. Moving towards a cure: blocking pathogenic antibodies in systemic lupus erythematosus. J Intern Med 2011;269:36–44.CrossRefGoogle ScholarPubMed