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Psychosis Associated with Anti-N-methyl-d-aspartate Receptor Antibodies

Published online by Cambridge University Press:  07 November 2014

Kevin M. Nasky ,
Douglas R. Knittel  and
Gail H. Manos
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Abstract

We describe the eighth case study of a female diagnosed with anti-N-methyl-d-aspartate receptor encephalitis without an identified tumor who presented with floridly psychotic symptoms following a 2-week prodromal phase with new-onset headaches and presyncopal episodes. While hospitalized, the patient had seizures, autonomic dysfunction, involuntary movements, and a decline in mental status. A subsequent assay was positive for anti-N-methyl-d-aspartate receptor antibodies. In contrast to most reported cases, an initial trial with corticosteroids was therapeutically unsuccessful. Subsequent treatment with intravenous immunoglobulins, however, resulted in a prompt, robust clinical response and enabled the patient to be rapidly discharged from the hospital, with minimal neuropsychiatrie sequelae.

Type
Case Report
Information
CNS Spectrums , Volume 13 , Issue 8 , August 2008 , pp. 699 - 703
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1.Dalmau, J, Bataller, L. Limbic encephalitis: the new cell membrane antigens and a proposal of clinical-immunological classification with therapeutic implications [Spanish]. Neurologia. 2007;22:526–537.Google Scholar
2.Corsellis, JA, Goldberg, GJ, Norton, AR. “Limbic encephalitis” and its association with carcinoma. Brain. 1968;91:481–496.CrossRefGoogle ScholarPubMed
3.Alamowitch, S, Graus, F, Uchuya, M, Reñé, R, Bescansa, E, Delattre, JY. Limbic encephalitis and small cell lung cancer. Clinical and immunological features. Brain. 1997;120(pt 6):923–928.CrossRefGoogle ScholarPubMed
4.Gultekin, SH, Rosenfeld, MR, Voltz, R, Eichen, J, Posner, JB, Dalmau, J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain. 2000;123(pt7):1481–1494.CrossRefGoogle ScholarPubMed
5.Iizuka, T, Sakai, F, Ide, T, et al.Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal. Neurology. 2008;70:504–511.CrossRefGoogle ScholarPubMed
6.Kataoka, H, Dalmau, J, Ueno, S. Paraneoplastic encephalitis associated with ovarian teratoma and N-methyl-d-aspartate receptor antibodies. Eur J Neurol. 2008;15:e5–e6.Google Scholar
7.Seki, M, Suzuki, S, Lizuka, T, et al.Neurological response to early removal of ovarian teratoma in anti-NMDAR encephalitis. J Neurol Neurosurg Psychiatry. 2008;79:324–326.Google Scholar
8.Dalmau, J, Tüzün, E, Wu, HY, et al.Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61:25–36.CrossRefGoogle ScholarPubMed
9.Graus, F, Dalmau, J. Paraneoplastic neurological syndromes: diagnosis and treatment. Curr Opin Neurol. 2007;20:732–737.Google Scholar
10.Linke, R, Schroeder, M, Helmberger, T, Voltz, R. Antibody-positive paraneoplastic neurologic syndromes: value of CT and PET for tumor diagnosis. Neurology. 2004;63:282–286.Google Scholar
11.Linke, R, Voltz, R. FDG-pet in paraneoplastic syndromes. Recent Results Cancer Res. 2008;170:203–211.Google Scholar
12.Sansing, LH, Tüzün, E, Ko, MW, Baccon, J, Lynch, DR, Dalmau, J. A patient with encephalitis associated with NMDA receptor antibodies. Nat Clin Pract Neurol. 2007;3:291–296.Google Scholar
13.Mori, H, Mishina, M. Structure and function of the NMDA receptor channel. Neuropharmacology. 1995;34:1219–1237.CrossRefGoogle ScholarPubMed
14.Waxman, EA, Lynch, DR. N-methyl-D-aspartate receptor subtypes: multiple roles in excitotoxicity and neurological disease. Neuroscientist. 2005;11:37–49.Google Scholar
15.Schatzberg, AF, Nemeroff, CB, eds. The American Psychiatric Publishing Textbook of Psychopharmacology. 3rd ed. Washington, DC: American Psychiatric Publishing; 2003.Google Scholar
16.Luby, ED, Gottlieb, JS, Cohen, BD, Rosenbaum, G, Domino, EF. Model psychoses and schizophrenia. Am J Psychiatry. 1962;119:61–67.Google Scholar
17.Rujescu, D, Bender, A, Keck, M, et al.A pharmacological model for psychosis based on N-methyl-D-aspartate receptor hypofunction: molecular, cellular, functional and behavioral abnormalities. Biol Psychiatry. 2006;59:721–729.CrossRefGoogle ScholarPubMed