Clinical Characteristics and Follow-Up of Seizures in Children With Anti-NMDAR Encephalitis

Objective: To analyze the seizure characteristics of children with anti-NMDAR encephalitis.Methods: This was a retrospective analysis of 50 children with anti-NMDAR encephalitis between July 1, 2013, and July 1, 2019.Results: Fifty children with anti-NMDAR encephalitis were included in this study, of which 34 (68.0%) had seizures. During the follow-up, three patients with anti-NMDAR encephalitis secondary to herpes simplex virus encephalitis had persistent seizures. The average duration of seizures in the remaining patients was 14.6 days (range 1–47 days). Compared to patients without seizures, those with seizures were more likely to experience consciousness disturbances (p = 0.008) and epileptic form discharge on electroencephalograms (p = 0.002). The Glasgow coma scale scores (p = 0.014), and Rankin scale scores (p = 0.019) were also different. The cranial MRI findings of children were reviewed, and clinical characteristics were compared between children without cranial lesions and those with lesions in the limbic system and neocortex. Compared to children in the non-lesion group, children with lesions in the limbic system and neocortex had a higher incidence of status epilepticus. Further, children in the limbic system and neocortical lesions groups were more likely to be taking anti-seizure medications (ASMs) and receive second-line drugs.Conclusion: Long-term oral ASMs are not recommended for most children with anti-NMDAR encephalitis. Children with involvement of the limbic system and neocortex are prone to status epilepticus, and sequelae of epilepsy may remain when the neocortex is involved.

Download Full-text

Anti-NMDAR Encephalitis Following Herpes Simplex Virus Encephalitis: 2 Cases From Portugal

The Neurohospitalist ◽

10.1177/1941874419870987 ◽

2019 ◽

Vol 10 (2) ◽

pp. 133-138

Author(s):

Ana Brás ◽

Ana André ◽

Laura Sá ◽

João Carvalho ◽

Anabela Matos ◽

...

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Specific Treatment ◽

Autoimmune Encephalitis ◽

Herpes Simplex Virus Encephalitis ◽

Virus Encephalitis ◽

Nmdar Encephalitis ◽

Initial Improvement ◽

Simplex Virus

Herpes simplex virus encephalitis (HSVE) usually presents as a monophasic disease. Symptomatic HSVE relapsing with seizures, encephalopathy, or involuntary movements associated with anti- N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis have been recently reported. We report 2 cases of adult post-HSVE anti-NMDAR encephalitis from Portugal. Two female patients aged 50 years and 30 years were diagnosed with herpes simplex virus type 2 and type 1 encephalitis, respectively. After the initial improvement with specific treatment and despite virologic negativization, both patients suffered clinical, electroencephalographic, and imaging deterioration. The autoimmune encephalitis hypothesis was confirmed with the demonstration of anti-NMDAR antibodies in both cerebrospinal fluid and serum. Both responded to human immunoglobulin and methylprednisolone, with progressive gain of autonomy along the follow-up period. Thymectomy for thymic hyperplasia diagnosed during follow-up was performed in 1 patient. Although being rare, post-HSVE anti-NMDAR encephalitis should be considered in all cases of symptomatic recrudescence after HSVE, since adequate immune-modulating treatment improves the outcome. The role of thyme hyperplasia in autoimmune encephalitis pathogenesis needs better understanding.

Download Full-text

ANTI-NMDAR ENCEPHALITIS POST HERPES SIMPLEX VIRUS ENCEPHALITIS

10.26226/morressier.56e174d0d462b8028d88a41a ◽

2016 ◽

Author(s):

Paula Carneiro

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Herpes Simplex Virus Encephalitis ◽

Virus Encephalitis ◽

Nmdar Encephalitis ◽

Simplex Virus

Download Full-text

Non-convulsive status epilepticus as an initial manifestation of herpes simplex virus encephalitis

Epileptic Disorders ◽

10.1684/epd.2021.1320 ◽

2021 ◽

Vol 23 (5) ◽

pp. 749-753

Author(s):

Marta Jeremić ◽

Mirjana Arsenijević ◽

Dejana Jovanović ◽

Ivana Berisavac

Keyword(s):

Herpes Simplex Virus ◽

Status Epilepticus ◽

Herpes Simplex ◽

Herpes Simplex Virus Encephalitis ◽

Convulsive Status Epilepticus ◽

Initial Manifestation ◽

Virus Encephalitis ◽

Simplex Virus

Download Full-text

NMDAR Encephalitis Following Herpes Simplex Virus Encephalitis

Current Infectious Disease Reports ◽

10.1007/s11908-017-0556-y ◽

2017 ◽

Vol 19 (1) ◽

Cited By ~ 10

Author(s):

Jonathan Galli ◽

Stacey L. Clardy ◽

Amanda L. Piquet

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Herpes Simplex Virus Encephalitis ◽

Virus Encephalitis ◽

Nmdar Encephalitis ◽

Simplex Virus

Download Full-text

Anti-N-Methyl-D-Aspartate receptor Encephalitis as a potential cause of worsening Herpes Simplex Virus Encephalitis.

Journal of the Pakistan Medical Association ◽

10.47391/jpma.694 ◽

2020 ◽

pp. 1-3

Author(s):

Saeed Arif ◽

Shaheer Arif ◽

Admin

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Neuronal Cell ◽

Autoimmune Encephalitis ◽

Herpes Simplex Virus Encephalitis ◽

Virus Encephalitis ◽

Aspartate Receptor ◽

Nmdar Encephalitis ◽

Intravenous Acyclovir ◽

Simplex Virus

Madam,Herpes Simplex Virus Encephalitis (HSVE) though rare tends to be lethal if acquired without treatment. The mortality of untreated HSE is up to 70% (1) and most patients don’t return to normal function (1). That said with prompt recognition and treatment with antiviral therapy the prognosis is considerably better (1). HSVE may become complicated by the presence of autoimmune encephalitis particularly Anti-N-Methyl-D-Aspartate receptor Encephalitis (NMDAR) (2). When this occurs the differentiation between two is not possible clinically and radiologically. In such situations the understanding and awareness of autoimmune encephalitis profile which also includes test for NMDAR antibodies becomes very important. Although such expensive tests have become available in Pakistan but the facility is present at only a hand full of centers along with unawareness of this possible condition making the situation worse. We encountered such a situation with our 60-years-old patient who initially presented with altered behaviour and recurrent episodes of focal seizures of left arm with secondary tonic clonic generalization. He was subsequently diagnosed with HSVE on cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) and was treated with intravenous acyclovir. Magnetic resonance imaging of the patient showed lesions in the insular cortex, hippocampus, medial frontal lobes and temporal lobes bilaterally (Figure 1). The patient had resolution of symptoms with relapse of altered behaviour eight weeks later. On CSF PCR for HSV this time was negative, with positive serum Anti-N-Methyl-D-Aspartate receptor (NMDAR) antibodies. This condition was treated with plasmapharesis and intravenous methylprednisolone without acyclovir.HSV has been postulated to induce autoimmunity against neuronal cell proteins (3, 4). Moreover, NMDAR Encephalitis has also been described in the literature as an etiology of “Relapsing Post-HSVE”, which is amenable to immune modulation if diagnosed and treated timely. Although one of the considered differential diagnosis in cases of relapse of HSVE, at the same time, NMDAR Encephalitis can also be a reason of worsening or lack of improvement of patients suffering from HSVE (1,2). These clinical situations may be missed by clinicians. So, it is important to differentiate among these clinical situations timely, which can be done easily by the antibody tests. This is important because the direction of therapy changes with initiation of immunotherapy if anti-NMDAR antibodies are tested positive. This may result in improvement in a large subset of patients (5).Continuous...

Download Full-text

Risk Factors for Nonconvulsive Status Epilepticus after Stroke

European Neurology ◽

10.1159/000496512 ◽

2018 ◽

Vol 80 (5-6) ◽

pp. 256-260 ◽

Cited By ~ 1

Author(s):

Shinya Tomari ◽

Tomotaka Tanaka ◽

Soichiro Matsubara ◽

Kazuki Fukuma ◽

Masafumi Ihara ◽

...

Keyword(s):

Risk Factors ◽

Status Epilepticus ◽

Clinical Characteristics ◽

Significant Risk ◽

Cardioembolic Stroke ◽

Frontal Lesion ◽

Seizure Recurrence ◽

Post Stroke ◽

Significant Difference

Background: Status epilepticus (SE) sometimes occurs after stroke. SE is classified as convulsive SE (CSE) and nonconvulsive SE (NCSE). Clinical characteristics, outcomes, mortality, and recurrences of post-stroke NCSE are yet to be clarified. Methods: We retrospectively identified post-stroke SE patients between April 2010 and September 2015, with follow-ups continued until March 2016. We compared baseline clinical characteristics (age, sex, past history of epilepsy, early seizure, stroke type, and localization) between the CSE and NCSE groups. We determined the Glasgow Outcome Scale (GOS) at discharge, along with the mortality and seizure recurrence rates for the two groups. Results: We identified 300 consecutive post-stroke seizure patients admitted to our department. A total of 50 post-stroke SE patients (33 men; mean age, 71.6 ± 14.2 years; 38 CSE; 12 NCSE; 20 ischemic strokes; 23 intracerebral hemorrhages; 7 subarachnoid hemorrhages) were included. Multivariable analysis showed that cardioembolic stroke and frontal lesion were significant risk factors of NCSE after stroke. GOS (Scale 1/2/3/4/5) results at patient discharge showed there was no significant difference between the groups (CSE; 8/26.3/18.4/26.3/21%, NCSE; 0/25/33/25/17%). Follow-up in 31 patients (21 CSE, 10 NCSE, median 815 days, interquartile range 538–1,327 days), revealed that seizure recurred in 15 CSE patients (71%) and in 4 NCSE patients (40%). During the follow-up, 3 CSE patients (14%) and 2 NCSE patients (20%) died. Seizure recurrence and mortality were not significantly different between the 2 groups. Conclusion: Cardioembolic stroke and frontal lesion were significant risk factors of NCSE after stroke.

Download Full-text