scholarly journals Psychotic Symptoms Related Anti NMDA Receptor in Ovarian Teratoma

2020 ◽  
Vol 1 (2) ◽  
pp. 1-8
Author(s):  
Ester G Panserga ◽  
Patricia Wulandari ◽  
Rachmat Hidayat
Keyword(s):  
Nmda Receptor ◽  
Neuropsychiatric Symptoms ◽  
Ovarian Teratoma ◽  
Psychotic Symptoms ◽  
Cellular Mechanisms ◽  
Delayed Treatment ◽  
Neurological Outcomes ◽  
Nmda Receptor Encephalitis ◽  
The Impact

Abstract Psychotic symptoms related ovarian teratoma are uncommon but has been well known in previous medical literature. Psychotic problems experienced by patients are often mistaken for psychological causes without organic causes, because commonly patients do not show symptoms associated with teratomas. Diagnosis of teratoma-related psychotic illnesses is often delayed due to the nature of the symptoms, that is leading to delayed treatment and worsen long-term neurological outcomes. Neuropsychiatric symptoms in teratoma can occur if it contains brain tissue inside and antibody anti-NMDA (N-methyl-D-Aspartate) receptor. The occurrence of psychotic symptoms in ovarian teratomas is based on cellular mechanisms. Antibodies bind to the NMDA receptor, which leads to the internalization of the cell surface and the relative state of the NMDA receptor hypofunction. While the impact of specific regions and circuit circuits of anti-NMDA receptor antibodies remains to be explored, the mechanism of anti-NMDA receptor encephalitis strengthens the hypothesis that NMDA receptor hypofunction may have a role in schizophrenia and psychosis.

scholarly journals Long-term Functional Outcomes and Relapse of Anti-NMDA Receptor Encephalitis

2021 ◽  
Vol 8 (2) ◽  
pp. e958
Author(s):  
Xue Gong ◽  
Chu Chen ◽  
Xu Liu ◽  
Jingfang Lin ◽  
Aiqing Li ◽  
...  
Keyword(s):  
Nmda Receptor ◽  
Functional Outcomes ◽  
Western China ◽  
Residual Symptoms ◽  
Delayed Treatment ◽  
Nmda Receptor Encephalitis ◽  
Disturbance Of Consciousness ◽  
Related Risk ◽  
Multiple Relapses

ObjectiveTo study the factors associated with relapse and functional outcomes in patients with anti-NMDA receptor encephalitis in Western China.MethodsThe Outcome of the anti-NMDA receptor Encephalitis Study in Western China was initiated in October 2011 to collect prospective observational data from consecutively enrolled patients with anti-NMDA receptor encephalitis.ResultsWe consecutively enrolled 244 patients (median age: 26 years, range: 9–78 years; females: 128 [52.45%]) between October 2011 and September 2019. Fatality occurred in 17 (6.96%) patients, and tumors were found in 38 (15.57%) patients. The median follow-up duration was 40 (6–96) months. Of these patients, 84.8% showed clinical improvements within 4 weeks after immunotherapy, with a median modified Rankin Scale of 2 (interquartile range [IQR]: 2–3), and 80.7% (median: 1, IQR: 0–2) and 85.7% (median: 0, IQR: 0–1) had substantial recovery (i.e., mild or no residual symptoms) at 12 and 24 months, respectively. The overall prognosis was still improving at 42 months after onset. Disturbance of consciousness during the first month was the only independent predictor (OR: 2.91, 95% CI: 1.27–6.65; p = 0.01) of a poor functional neurologic outcome. Overall, 15.9% of the patients had one or multiple relapses, with 82.0% experiencing the first relapse within 24 months and 76.9% experiencing relapses that were less severe than the initial episodes. Relapse-related risk factors included the female sex and delayed treatment (p < 0.05).ConclusionsMost patients achieved favorable long-term functional outcomes. Some patients experienced one or multiple relapses, especially female patients. Timely immunotherapy at onset may reduce the risk of relapse.

scholarly journals Neurogenic bladder in an adolescent woman with an ovarian tumour: an unusual presentation of anti-NMDA-receptor encephalitis

2019 ◽  
Vol 12 (8) ◽  
pp. e229626
Author(s):  
Natasha Soong-Ying Liou ◽  
Fredric Willmott
Keyword(s):  
Nmda Receptor ◽  
Neurogenic Bladder ◽  
Neuropsychiatric Symptoms ◽  
Pelvic Mass ◽  
Therapeutic Benefit ◽  
Ovarian Tumour ◽  
Ovarian Teratoma ◽  
Surgical Removal ◽  
Rapid Improvement ◽  
Nmda Receptor Encephalitis

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is rarely seen in women with ovarian teratoma. It is characterised by neuropsychiatric symptoms and may also cause autonomic imbalance. We present the case of a 16-year-old nulliparous woman who presented with an acute history of seizures and neurogenic bladder. Antiviral and antiepileptic therapy conferred no therapeutic benefit. A cystic pelvic mass measuring 185×140×92 mm was identified separate from the bladder. Serum titres of NMDA receptor antibodies were significantly elevated. The mass was surgically removed and histology revealed benign ovarian teratoma with NMDA receptors. The patient made a rapid improvement and had full resolution of urinary and neuropsychiatric symptoms within 1 year. This case demonstrates that increased awareness in adolescents is crucial for avoiding symptom dismissal, misdiagnosis and inappropriate treatment of this condition. Surgical removal of the teratoma should be the first line therapy of anti-NMDA-receptor encephalitis as this often leads to symptom resolution soon after.

scholarly journals Anti-NMDA-receptor encephalitis presenting with catatonia and neuroleptic malignant syndrome in patients with intellectual disability and autism

2015 ◽  
Vol 39 (1) ◽  
pp. 32-35 ◽  
Author(s):  
Reza Kiani ◽  
Mark Lawden ◽  
Penelope Eames ◽  
Peter Critchley ◽  
Sabyasachi Bhaumik ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Nmda Receptor ◽  
Neuroleptic Malignant Syndrome ◽  
Case Reports ◽  
Neuropsychiatric Symptoms ◽  
Clinical Issue ◽  
Nmda Receptor Encephalitis ◽  
The Way

SummaryWe report anti-N-methyl-d-aspartate (NMDA) receptor encephalitis in two patients with autism and intellectual disability presenting with neuropsychiatric symptoms of catatonia and neuroleptic malignant syndrome. Case reports such as these help raise awareness of this clinical issue. By paving the way for earlier diagnoses they ultimately maximise the potential for curative treatments and prevention of long-term complications.

scholarly journals Ovarectomy despite Negative Imaging in Anti-NMDA Receptor Encephalitis: Effective Even Late

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Anna-Lena Boeck ◽  
Frank Logemann ◽  
Terence Krauß ◽  
Kais Hussein ◽  
Eva Bültmann ◽  
...  
Keyword(s):  
Nmda Receptor ◽  
Clinical Syndrome ◽  
Ovarian Teratoma ◽  
Intensive Care Treatment ◽  
Important Lesson ◽  
Nmda Receptor Encephalitis ◽  
Nmdar Encephalitis ◽  
Negative Imaging ◽  
Instructive Case

Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune antibody-mediated neuropsychiatric disorder. The disorder is known to be associated with ovarian teratoma and predominantly affects young women. Here, we report the case of a 34-year-old woman with anti-NMDAR encephalitis, in which detailed investigations gave no specific hint for an ovarian teratoma. Despite this, and due to a continuous severe clinical syndrome, an ovarectomy was performed and histological examination revealed an occult teratoma. The ovarectomy led to a remarkable improvement even with a long term intensive care treatment for 11 months. The most important lesson to be learned from this instructive case is that even though none of the investigations was indicative for an ovarian teratoma, including an explorative laparoscopy with biopsy, there still may be an occult ovarian teratoma. This shows that tumour search and diagnosis are extremely important in patients presenting with anti-NMDAR encephalitis, and a laparotomy and ovarectomy is justified. Furthermore, removal of the teratoma even 11 months after a very severe course is still therapeutically effective.

scholarly journals Complete cognitive recovery in a severe case of anti-N-methyl-d-aspartate receptor encephalitis treated with electroconvulsive therapy

2020 ◽  
Vol 13 (2) ◽  
pp. e233772
Author(s):  
Cæcilie Leding ◽  
Lisbet Marstrand ◽  
Anders Jorgensen
Keyword(s):  
Nmda Receptor ◽  
Electroconvulsive Therapy ◽  
Neuropsychiatric Symptoms ◽  
Behavioural Change ◽  
Severe Case ◽  
Cognitive Outcome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cognitive Domains ◽  
Nmda Receptor Encephalitis

Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis usually presents with prominent neuropsychiatric symptoms and many patients experience cognitive sequelae. Electroconvulsive therapy (ECT) has been suggested as a part of the treatment, particularly for catatonia, but concerns that ECT may worsen the cognitive function and long-term outcome may limit its use. We present a case of anti-NMDA receptor encephalitis with severe neuropsychiatric manifestations including refractory catatonia and behavioural change. A pre-ECT neuropsychological assessment revealed dysfunction in multiple cognitive domains in spite of intensive pharmacological treatment. Twenty days after the ninth and last ECT treatment, the patient underwent the same neuropsychological tests, which showed normalised test results within all cognitive domains and no need of rehabilitation. The case demonstrates that the use of ECT in anti-NMDA receptor encephalitis with severe pretreatment cognitive dysfunction can be associated with a highly favourable cognitive outcome.

scholarly journals The individual course of neuropsychiatric symptoms in people with Alzheimer's and Lewy body dementia: 12-year longitudinal cohort study

2019 ◽  
Vol 216 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Audun Osland Vik-Mo ◽  
Lasse Melvaer Giil ◽  
Miguel Germán Borda ◽  
Clive Ballard ◽  
Dag Aarsland
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Neuropsychiatric Symptoms ◽  
Personalised Medicine ◽  
Lewy Bodies ◽  
Lewy Body Dementia ◽  
Psychotic Symptoms ◽  
Primary Inclusion ◽  
The Individual

IntroductionUnderstanding the natural course of neuropsychiatric symptoms (NPS) in dementia is important for planning patient care and trial design, but few studies have described the long-term course of NPS in individuals.MethodPrimary inclusion of 223 patients with suspected mild dementia from general practice were followed by annual assessment, including the Neuropsychiatric Inventory (NPI), for up to 12 years. Total and item NPI scores were classified as stable, relapsing, single episodic or not present based on 4.96 (s.d. 2.3) observations (98% completeness of longitudinal data) for 113 patients with Alzheimer's disease and 84 patients with LBD (68 dementia with Lewy bodies and 16 Parkinson's disease dementia).ResultsWe found that 80% had stable NPI total ≥1, 50% had stable modest NPI total ≥12 and 25% had stable NPI total ≥24 scores. Very severe NPS (≥48) were mostly single episodes, but 8% of patients with Alzheimer's disease had stable severe NPS. Patients with Alzheimer's disease and the highest 20% NPI total scores had a more stable or relapsing course of four key symptoms: aberrant motor behaviour, aggression/agitation, delusions and irritability (odds ratio 55, P < 0.001). This was not seen in LBD. Finally, 57% of patients with Alzheimer's disease and 84% of patients with LBD had reoccurring psychotic symptoms.ConclusionsWe observed a highly individual course of NPS, with most presenting as a single episode or relapsing; a stable course was less common, especially in LBD. These findings demonstrate the importance of an individualised approach (i.e. personalised medicine) in dementia care.

scholarly journals A Case of Anti-NMDA Receptor Encephalitis with a History of Removal of Ovarian Teratoma

2013 ◽  
Vol 102 (11) ◽  
pp. 2972-2975
Author(s):  
Miho Kawabe ◽  
Yukifusa Igeta ◽  
Taro Bannai ◽  
Hideyuki Matsumoto ◽  
Hideji Hashida
Keyword(s):  
Nmda Receptor ◽  
Ovarian Teratoma ◽  
Nmda Receptor Encephalitis ◽  
History Of

scholarly journals RARE-36. BORTEZOMIB WOKE UP A PATIENT WITH ANTI-NMDA RECEPTOR ENCEPHALITIS REFRACTORY TO STANDARD THERAPY AND LONG TERM FOLLOW-UP

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi229-vi229
Author(s):  
Kong Xiao-Tang ◽  
Leonid Groysman ◽  
Cyrus Dastur ◽  
Beverly Fu ◽  
Daniela Bota
Keyword(s):  
Nmda Receptor ◽  
Standard Therapy ◽  
Autoimmune Encephalitis ◽  
Ivig Therapy ◽  
Term Care ◽  
Good Communication ◽  
Nmda Receptor Encephalitis ◽  
Long Term Follow Up ◽  
One Year

Abstract OBJECTIVE To report a case with refractory NMDA encephalitis in comatose for 18 months, who was treated successfully with bortezomib. BACKGROUND Anti-NMDA encephalitis is a rare autoimmune encephalitis. Standard therapy include corticosteroid, IVIG or plasma exchange, cyclophosphamide, rituximab, and tumor removal. Refractory cases are very severe and often stay in ICU on ventilation for several months to years. Bortezomib for the treatment of refractory anti-NMDA receptor encephalitis was reported. We have applied the treatment to our refractory case and successfully woke up the patient. And we have followed up the patient for 3 years. METHODS Case report. RESULTS A 40 yo male was diagnosed as anti-NMDA encephalitis. Standard therapy was applied. After stabilization, the patient was eventually discharged to ICU at a long term care subacute hospital. The patient was brought back for more Rituxan or steroid or IVIG therapy. The condition had not improved at all. Eighteen months in comatose, the patient had worsening NMDA titer in CSF to 1:640. Decision was made to start bortezumib as reported with modification: 1.3 mg/m2 bortezomib were administered on days 1, 8, 11 and 14 and allowed two weeks off therapy. After first cycle, the patent started to talk first word “hurt.” After 6 cycles, the patient sat up and started riding bicycles for physical therapy. The NMDA titer in CSF was reduced to 1:40 at the end of 6 cycles. One year later, the patent stood up and ambulated with a walker. One and half year later, the patient walks without assistance and his speech and cognition have significantly improved with good communication with family members and staff. CONCLUSIONS Proteasome inhibitor bortezomib might be considered to be the third line therapy as early as possible if the first line and second line are ineffective to treat anti-NMDA receptor encephalitis.

scholarly journals Electroconvulsive therapy can improve psychotic symptoms in anti-NMDA-receptor encephalitis

2012 ◽  
Vol 66 (3) ◽  
pp. 242-243 ◽  
Author(s):  
Takuya Matsumoto ◽  
Kenji Matsumoto ◽  
Toshiyuki Kobayashi ◽  
Satoshi Kato
Keyword(s):  
Nmda Receptor ◽  
Electroconvulsive Therapy ◽  
Psychotic Symptoms ◽  
Nmda Receptor Encephalitis
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