Anti-N-Methyl-D-Aspartate-Receptor Encephalitis: A 10-Year Follow-Up.
anti-N-methyl-D-aspartate-receptor encephalitis
antibodies
catatonia
follow-up
long-term
neuroleptics
psychotherapy
Journal
Frontiers in psychiatry
ISSN: 1664-0640
Titre abrégé: Front Psychiatry
Pays: Switzerland
ID NLM: 101545006
Informations de publication
Date de publication:
2020
2020
Historique:
received:
06
01
2020
accepted:
12
03
2020
entrez:
2
6
2020
pubmed:
2
6
2020
medline:
2
6
2020
Statut:
epublish
Résumé
Anti-N-methyl-D-aspartate-receptor (NMDA-R) encephalitis is an autoimmune disease of the brain first described in 2007. The aim of this paper is to present a 10-year follow-up case history. The authors present the case of a 39-year-old female patient who developed an anti-NMDA-R encephalitis in 2009 with predominant severe catatonic symptoms. Anti-inflammatory therapy led to the disappearance of catatonic symptoms and was discontinued during the course of the disease. After acute therapy, the patient achieved an almost full recovery presenting with ongoing discrete symptoms of sensory overload, subtle cognitive deficits, and fatigue/reduced energy levels. The follow-up investigation in 2019 showed inconspicuous findings in laboratory diagnostics and magnetic resonance imaging. Electroencephalography (EEG) analysis using independent component analysis detected left hemispherical spike-wave complexes and intermittent slowing. Regarding the sensory overload and reduced energy level, the patient benefited from low-dose neuroleptics (risperidone, amisulpride). In terms of sensory overload associated with experiences of panic, cognitive deficits and coping with the disease, she improved with cognitive behavioral therapy (CBT). Anti-inflammatory treatment led to almost full recovery with persistent disappearance of catatonic symptoms; however, a dysexecutive syndrome led to ongoing relevant problems with good response to low-dose atypical neuroleptics and CBT. The patient had persistent EEG alterations that indicated continuing neuronal network instability. Therefore, the case demonstrates the importance of multidisciplinary outpatient treatment following acute therapy for anti-NMDA-R encephalitis in patients with ongoing psychiatric deficits. For the symptomatic treatment of executive dysfunctions, "classical" psychiatric treatment may be helpful in the course of the disease.
Sections du résumé
BACKGROUND
BACKGROUND
Anti-N-methyl-D-aspartate-receptor (NMDA-R) encephalitis is an autoimmune disease of the brain first described in 2007. The aim of this paper is to present a 10-year follow-up case history.
CASE PRESENTATION
METHODS
The authors present the case of a 39-year-old female patient who developed an anti-NMDA-R encephalitis in 2009 with predominant severe catatonic symptoms. Anti-inflammatory therapy led to the disappearance of catatonic symptoms and was discontinued during the course of the disease. After acute therapy, the patient achieved an almost full recovery presenting with ongoing discrete symptoms of sensory overload, subtle cognitive deficits, and fatigue/reduced energy levels. The follow-up investigation in 2019 showed inconspicuous findings in laboratory diagnostics and magnetic resonance imaging. Electroencephalography (EEG) analysis using independent component analysis detected left hemispherical spike-wave complexes and intermittent slowing. Regarding the sensory overload and reduced energy level, the patient benefited from low-dose neuroleptics (risperidone, amisulpride). In terms of sensory overload associated with experiences of panic, cognitive deficits and coping with the disease, she improved with cognitive behavioral therapy (CBT).
CONCLUSION
CONCLUSIONS
Anti-inflammatory treatment led to almost full recovery with persistent disappearance of catatonic symptoms; however, a dysexecutive syndrome led to ongoing relevant problems with good response to low-dose atypical neuroleptics and CBT. The patient had persistent EEG alterations that indicated continuing neuronal network instability. Therefore, the case demonstrates the importance of multidisciplinary outpatient treatment following acute therapy for anti-NMDA-R encephalitis in patients with ongoing psychiatric deficits. For the symptomatic treatment of executive dysfunctions, "classical" psychiatric treatment may be helpful in the course of the disease.
Identifiants
pubmed: 32477169
doi: 10.3389/fpsyt.2020.00245
pmc: PMC7242611
doi:
Types de publication
Case Reports
Langues
eng
Pagination
245Informations de copyright
Copyright © 2020 Meixensberger, Tebartz van Elst, Schweizer, Maier, Prüss, Feige, Denzel, Runge, Nickel, Matysik, Venhoff, Domschke, Urbach, Perlov and Endres.
Références
Lancet Neurol. 2013 Feb;12(2):157-65
pubmed: 23290630
J Clin Exp Neuropsychol. 2018 Apr;40(3):234-252
pubmed: 28585453
eNeurologicalSci. 2019 Jul 19;16:100199
pubmed: 31384674
Front Neurol. 2019 Nov 05;10:1086
pubmed: 31749755
Nervenarzt. 2019 Jul;90(7):745-761
pubmed: 31197396
Lancet Neurol. 2016 Apr;15(4):391-404
pubmed: 26906964
J Epilepsy Res. 2018 Jun 30;8(1):41-48
pubmed: 30090761
BMC Psychiatry. 2015 Aug 01;15:186
pubmed: 26231521
Lancet Neurol. 2008 Dec;7(12):1091-8
pubmed: 18851928
Lancet Neurol. 2019 Nov;18(11):1045-1057
pubmed: 31326280
Neuropsychiatr Dis Treat. 2017 Feb 08;13:339-345
pubmed: 28223808
Curr Psychiatry Rev. 2011;7(3):189-193
pubmed: 24729779
Physiol Rev. 2017 Apr;97(2):839-887
pubmed: 28298428
Nervenarzt. 2019 May;90(5):547-563
pubmed: 30968197
Epilepsy Behav. 2011 Oct;22(2):231-9
pubmed: 21784710
Ann Neurol. 2007 Jan;61(1):25-36
pubmed: 17262855
N Engl J Med. 2018 Mar 1;378(9):840-851
pubmed: 29490181
NeuroRehabilitation. 2014;35(4):863-75
pubmed: 25323083