PMID- 23806220
OWN - NLM
STAT- MEDLINE
DCOM- 20130904
LR  - 20211021
IS  - 0722-5091 (Print)
IS  - 0722-5091 (Linking)
VI  - 32
IP  - 4
DP  - 2013 Jul-Aug
TI  - Clinical Neuropathology practice guide 4-2013: post-herpes simplex encephalitis: 
      N-methyl-Daspartate receptor antibodies are part of the problem.
PG  - 251-4
AB  - Classic herpes simplex virus encephalitis (HSVE) is an acute viral infection that 
      usually follows a monophasic disease course; however some patients, mainly 
      children, experience a relapse within weeks or months after the initial event. In 
      a subset of these patients a viral reactivation is unlikely because the CSF PCR 
      for HSV is negative, repeated MRI does not show new necrotic lesions, and the 
      symptoms are refractory to antiviral therapy. These patients often develop 
      choreoathetosis variably accompanied by behavioral changes and seizures, and a 
      postinfectious immune-mechanism has been postulated. Recent studies demonstrated 
      that 7% of patients with HSVE harbor NR1 N-methyl-D-aspartate receptor (NMDAR) 
      IgG antibodies. Moreover, a child with post- HSVE choreoathetosis was found to 
      have NMDAR antibodies; the patient did not improve with antiviral therapy but 
      recovered after aggressive immunotherapy. Based on these findings, evidence is 
      increasing that a subgroup of post-HSVE represents a separate disease entity, 
      which in fact is anti-NMDAR encephalitis. Patients with relapsing HSVE or 
      prolonged atypical symptoms, who have negative CSF PCR for HSV should routinely 
      be tested for NMDAR IgG antibodies in CSF and serum. It is important to be aware 
      of this differential diagnosis because patients respond to immunotherapy.
FAU - Hoftberger, Romana
AU  - Hoftberger R
AD  - Institute of Neurology, Medical University of Vienna, Austria. 
      romana.hoeftberger@meduniwien.ac.at
FAU - Armangue, Thais
AU  - Armangue T
FAU - Leypoldt, Frank
AU  - Leypoldt F
FAU - Graus, Francesc
AU  - Graus F
FAU - Dalmau, Josep
AU  - Dalmau J
LA  - eng
GR  - R01 NS077851/NS/NINDS NIH HHS/United States
GR  - R01CA089054/CA/NCI NIH HHS/United States
GR  - R01NS077851/NS/NINDS NIH HHS/United States
GR  - R01MH094741/MH/NIMH NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - Germany
TA  - Clin Neuropathol
JT  - Clinical neuropathology
JID - 8214420
RN  - 0 (Autoantibodies)
RN  - 0 (Autoantigens)
RN  - 0 (Receptors, N-Methyl-D-Aspartate)
SB  - IM
MH  - Anti-N-Methyl-D-Aspartate Receptor Encephalitis/*immunology/virology
MH  - Autoantibodies/*immunology
MH  - Autoantigens/immunology
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Male
MH  - Neuralgia, Postherpetic/*immunology
MH  - *Practice Guidelines as Topic
MH  - Receptors, N-Methyl-D-Aspartate/*immunology
PMC - PMC3749751
EDAT- 2013/06/29 06:00
MHDA- 2013/09/05 06:00
PMCR- 2013/07/01
CRDT- 2013/06/29 06:00
PHST- 2013/06/29 06:00 [entrez]
PHST- 2013/06/29 06:00 [pubmed]
PHST- 2013/09/05 06:00 [medline]
PHST- 2013/07/01 00:00 [pmc-release]
AID - 10720 [pii]
AID - 10.5414/np300666 [doi]
PST - ppublish
SO  - Clin Neuropathol. 2013 Jul-Aug;32(4):251-4. doi: 10.5414/np300666.