scholarly journals Cognitive profile in anti-NMDAR encephalitis: Neuropsychological evaluation, rehabilitation, and evolution. A case report

2021 ◽  
Vol 4 (Spring 2021) ◽  
Author(s):  
Nuria Montoro-Membila ◽  
Angel Gómez-Camello ◽  
Inmaculada Villegas-Rodríguez ◽  
Mónica Triviño-Mosquera
Keyword(s):  
Emotional Regulation ◽  
Muscular Activity ◽  
Ovarian Teratoma ◽  
Neuropsychological Evaluation ◽  
Neuropsychological Rehabilitation ◽  
Neuropsychological Profile ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Immune Mediated ◽  
Before And After

Encephalitis associated with antibodies against the N-methyl-D-aspartate receptor (i.e., anti-NMDAR encephalitis) is an immune-mediated disorder mainly affecting girls and young women with ovarian teratoma. The clinical picture of the disease progresses from headaches and seizures, psychopathological symptoms (i.e., anxiety, psychosis, or hyperreligiosity), and neuropsychological deficits (i.e., memory, attention, and language disintegration) into a state of agitation, catatonia, dysautonomia (i.e., abnormal movements due to inappropriate muscular activity) and facial dyskinesia. Reports of the neuropsychological profile and evolution, as well as the neuropsychological rehabilitation in anti-NMDAR encephalitis in the literature are scarce. We present the case of a 21-year-old woman diagnosed with anti-NMDAR encephalitis and we describe the different neuropsychological evaluation tests performed before and after neuropsychological rehabilitation during the acute period. A profile of fronto-subcortical neuropsychological damage was observed, with executive functions and emotional regulation affected.

Anti-NMDA receptor encephalitis in the practice of a psychiatrist on the example of a clinical case

2021 ◽  
pp. 586-593
Author(s):  
Kristina S. Gareeva ◽  
Rinat G. Valinurov ◽  
Dmitriy F. Khritinin
Keyword(s):  
Involuntary Movement ◽  
Multidisciplinary Treatment ◽  
Disease Onset ◽  
Autoimmune Encephalitis ◽  
Ovarian Teratoma ◽  
Nmda Receptor Encephalitis ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
The Central Nervous System ◽  
Severity Of The Disease

Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a treatable autoimmune disease of the central nervous system (CNS) with prominent neurologic and psychiatric features at disease onset. Anti-NMDAR encephalitis can occur in all ages. The disorder predominantly affects children and young adults, occurs with or without tumour association, and can relapse. The presence of a tumour (usually an ovarian teratoma) is dependent on age, sex, and ethnicity, being more frequent in women older than 18 years. Primarily presents in the form of mental disorders, seizures, and involuntary movement, and is often accompanied by sleep disorders and prominent speech difficulties. Anti-NMDAR encephalitis in children may present differently than in adults. Children are more likely to have abnormal movements (chorea, incoordination) early in the disease course and also may have atypical motor symptoms such as ataxia or hemiparesis. Children more often have seizures than adults. The classic symptoms of psychosis seen in adults are less common, but behavioral regression is frequently noted. The proper diagnosis and management of autoimmune encephalitis requires a multidisciplinary treatment approach. Ancillary testing with MRI, EEG, lumbar puncture and immunological assessment of cerebrospinal fluid and serum may further support a diagnosis of encephalitis and potentially suggest particular causes. Early immune-modulatory treatment can alleviate the severity of the disease and improve the cure rate. Further study of anti-NMDAR antibody and its related encephalitis would give essential clues for the research of schizophrenia, catatonia, and atypical psychosis.

scholarly journals REMISSION OF TREATMENT RESISTANT SCHIZOPHRENIA FOLLOWING RESECTION OF OVARIAN TERATOMA: A CASE OF ANTI-NMDAR ENCEPHALITIS

2019 ◽  
Author(s):  
Su Tein Sim
Keyword(s):  
Psychiatric Symptoms ◽  
Poor Response ◽  
Neurological Deficits ◽  
Response To Treatment ◽  
Ovarian Teratoma ◽  
Treatment Resistant ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Brain Circuitry ◽  
High Index Of Suspicion

Objective: Ovarian teratoma has been frequently associated with Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis in recent years since its discovery by Dalmao in the year 2007. Most patients with anti-NMDAR encephalitis develop a multistage illness that progresses from psychosis, memory deficits, seizures, and language disintegration into a state of unresponsiveness with catatonic features often associated with abnormal movements, and autonomic and breathing instability. Milder or incomplete forms of the disorder in which patients develop predominant or apparently isolated psychiatric symptoms are uncommon. The overlap of symptomatology between anti-NMDAR encephalitis and schizophrenia often result in misdiagnosis. This case represents a forme fruste of ovarian teratoma related anti-NMDAR encephalitis which only presents with psychiatric and cognitive symptoms without obvious neurological deficits. Method: We report a case of a 37-year-old lady diagnosed with Treatment-Resistant Schizophrenia (TRS) who had a poor response to treatment despite multiple trials of antipsychotics and electroconvulsive therapy. Results: Our patient achieved remission following the excision of the ovarian teratoma and had been maintaining well with minimal psychotropic intervention. Conclusion: This case suggests that clinicians should always have a high index of suspicion for anti-NMDAR encephalitis in young women presenting with new-onset psychiatric symptoms and/or treatment-resistant psychosis. More research is needed to shed light on the exact role of NMDAR within the brain circuitry and the effects of its modulation in both Schizophrenia and anti-NMDAR encephalitis.

scholarly journals Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Decrease in Blood Flow in Cerebellum

2021 ◽  
pp. 17-23
Author(s):  
Koji Obara ◽  
Tomoko Ono ◽  
Itaru Toyoshima
Keyword(s):  
Working Memory ◽  
Blood Flow ◽  
Ovarian Teratoma ◽  
Emission Computed Tomography ◽  
High Dose ◽  
Promising Alternative ◽  
Flow Monitoring ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Consciousness Disturbance

In anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, progressive cerebellar atrophy potentially leads to severe sequelae. We encountered a patient with anti-NMDAR antibody encephalitis who showed a decrease of blood flow in the cerebellum. A 15-year-old girl presented with consciousness disturbance. Influenza encephalopathy was suspected, and she was treated with glucocorticoid pulse therapy, high-dose intravenous immunoglobulins, and plasma exchange sequentially. She subsequently underwent left oophorectomy due to the presence of anti-NMDAR antibodies and a left ovarian teratoma. In spite of the surgery, her neuropsychiatric symptoms persisted, and she recovered slowly after the introduction of oral methotrexate (MTX). Sequential cerebral blood flow monitoring with single-photon emission computed tomography showed marked cerebellar hypoperfusion. Although mild impairments including working memory and verbal fluency persisted, she eventually returned to high school 3 years after onset. Profound cerebellar hypoperfusion including lobules VI and VII may be the reason for her working memory impairment and speaking problems. Oral MTX may be a promising alternative treatment for some refractory cases of anti-NMDAR encephalitis.

Socio-Emotional and Academic Learning Before and After COVID-19 School Closures: Evidence from Ethiopia

2021 ◽  
Author(s):  
Stephen Bayley ◽  
Darge Wole Meshesha ◽  
Paul Ramchandani ◽  
Pauline Rose ◽  
Tassew Woldehanna ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Skills ◽  
Emotional Regulation ◽  
Current Knowledge ◽  
Strong Relationship ◽  
Academic Learning ◽  
School Closures ◽  
Health And Wellbeing ◽  
Before And After ◽  
Children's Social Skills

This paper presents the findings of research undertaken in Ethiopia to examine the effects of COVID-19 school closures on children’s holistic learning, including both socio-emotional and academic learning. It draws on data collected in 2019 (prior to the pandemic) and 2021 (after schools reopened) to compare primary pupils’ learning before and after the school closures. In particular, the study adapts self-reporting scales that have been used in related contexts to measure Grade 3 and 6 children’s social skills, self-efficacy, emotional regulation and mental health and wellbeing, along with literacy and numeracy. Lesson observations were also undertaken to explore teachers’ behaviours to foster socio-emotional learning (SEL) in the classroom. The findings advance current knowledge in several respects. First, they quantify the decline in Ethiopian pupils’ social skills over the period of the school closures. Second, they identify a significant and strong relationship between learners’ social skills and their numeracy, even after taking other factors into account. Third, they reveal a significant association between children’s social skills and their mental health and wellbeing, highlighting the importance of interpersonal interactions to safeguard children’s holistic welfare. The paper concludes by proposing a model for understanding the relationship between learners’ SEL and academic outcomes, and with recommendations for education planning and practice, in Ethiopia and elsewhere.

scholarly journals Expression of Various Glutamate Receptors Including N-Methyl-D-Aspartate Receptor (NMDAR) in an Ovarian Teratoma Removed from a Young Woman with Anti-NMDAR Encephalitis

2010 ◽  
Vol 49 (19) ◽  
pp. 2167-2173 ◽  
Author(s):  
Naoko Tachibana ◽  
Takashi Shirakawa ◽  
Keiko Ishii ◽  
Yukitoshi Takahashi ◽  
Keiko Tanaka ◽  
...  
Keyword(s):  
Glutamate Receptors ◽  
Young Woman ◽  
Ovarian Teratoma ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis

Does MAP2 have a Role in Predicting the Development of Anti-NMDAR Encephalitis Associated with Benign Ovarian Teratoma? A Report of Six New Pediatric Cases

2015 ◽  
Vol 18 (2) ◽  
pp. 122-126 ◽  
Author(s):  
Caitlin A. Cundiff ◽  
Nancy Elawabdeh ◽  
Mina M. Naguib ◽  
Samuel N. Jactel ◽  
Dina El Demellawy ◽  
...  
Keyword(s):  
Ovarian Teratoma ◽  
Nmdar Encephalitis

scholarly journals Case Report: Severe Adolescent Major Depressive Syndrome Turns Out to Be an Unusual Case of Anti-NMDA Receptor Encephalitis

2021 ◽  
Vol 12 ◽  
Author(s):  
Alexander Moldavski ◽  
Holger Wenz ◽  
Bettina E. Lange ◽  
Cathrin Rohleder ◽  
F. Markus Leweke
Keyword(s):  
Cognitive Deficits ◽  
Psychiatric Symptoms ◽  
Previous History ◽  
Rapid Onset ◽  
Depressive Syndrome ◽  
Psychotic Symptoms ◽  
Major Depressive ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Initial Symptoms

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory condition mediated by autoantibodies against the GluN1 subunit of the receptor. Clinically, it is characterized by a complex neuropsychiatric presentation with rapidly progressive psychiatric symptoms, cognitive deficits, seizures, and abnormal movements. Isolated psychiatric manifestations of anti-NMDAR encephalitis are rare and usually dominated by psychotic symptoms. We present a case of an 18-year-old female high school student—without a previous history of psychiatric disorders—with a rapid onset severe depressive syndrome. Surprisingly, we found pleocytosis and anti-NMDAR autoantibodies in the cerebrospinal fluid (CSF), despite an otherwise unremarkable diagnostic workup, including blood test, clinical examination, and cranial magnetic resonance imaging (MRI). After intravenous immunoglobulins treatment, a complete remission of the initial symptoms was observed. In a follow-up 5 years later, the young woman did not experience any relapse or sequelae. Anti-NMDAR encephalitis can present in rare cases as an organic disorder with major depressive symptoms without distinct concomitant psychotic or neurological symptoms. A clinical presentation such as a rapid onset of symptoms, distinct disturbance in the thought process, restlessness, and cognitive deficits should prompt screening for NMDAR- and other neural autoantibodies to rule out this rare but debilitating pathology.

scholarly journals Anti-n-Methyl-d-Aspartate-Receptor (NMDAR) Encephalitis in Association with Ovarian Teratoma

Cureus ◽  
2017 ◽  
Author(s):  
Javaad Ahmad ◽  
Muhammad Saad Sohail ◽  
Amina Khan ◽  
Ahmed H Qavi ◽  
Pramod Gaudel ◽  
...  
Keyword(s):  
Ovarian Teratoma ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis

scholarly journals Remove the Ovarian Tumor, Cure the Encephalitis: Anti-NMDAR Encephalitis With Ovarian Teratoma in a Tertiary Hospital in Singapore

2017 ◽  
Vol 8 (2) ◽  
pp. 52-57
Author(s):  
Ka Hee Chua ◽  
Andy Wei Keat Tan ◽  
Serene Liqing Lim ◽  
Wahab Syed Shahul Hameed ◽  
Siew Ju See ◽  
...  
Keyword(s):  
Ovarian Tumor ◽  
Tertiary Hospital ◽  
Ovarian Teratoma ◽  
Nmdar Encephalitis

Trait and State Anxiety before and after Competitive Performance

1995 ◽  
Vol 81 (3_suppl) ◽  
pp. 1059-1074 ◽  
Author(s):  
Hallgeir Halvari ◽  
Torgrim Gjesme
Keyword(s):  
State Anxiety ◽  
Motor Task ◽  
Muscular Activity ◽  
Critical Factor ◽  
Physical Strength ◽  
Performance Errors ◽  
Before And After ◽  
Trait And State Anxiety ◽  
Direction Of Movement ◽  
And Performance

33 subjects were tested on competitive trait and state anxiety immediately before and after a competitive motor task of short duration (average performance time of 25 seconds). It required precise coordination of correct muscular activity, timing as well as speed, and physical strength that included explosive shifts in direction of movement. Two types of performance measures were employed, (a) number of errors during the performance and (b) the time it took to complete the motor task. Analysis showed a positive relation between trait anxiety and performance errors when a linear model was applied; however, when a curvilinear model was used, a strong significant U-relationship between errors and precompetition state anxiety emerged. Further, a strong positive linear relation between poststate anxiety and number of performance errors was observed. The results indicate that making errors in performance situations is a critical factor in producing postcompetition state anxiety.

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