PMID- 25061311
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20140725
LR  - 20240321
IS  - 1176-6336 (Print)
IS  - 1178-203X (Electronic)
IS  - 1176-6336 (Linking)
VI  - 10
DP  - 2014
TI  - Anti-N-methyl-D-aspartate-receptor encephalitis: diagnosis, optimal management, 
      and challenges.
PG  - 517-25
LID - 10.2147/TCRM.S61967 [doi]
AB  - OBJECTIVE: Anti-N-methyl-D-aspartate-receptor (NMDA-R) encephalitis is a new 
      autoimmune disorder, often paraneoplastic in nature, presenting with complex 
      neuropsychiatric symptoms. Diagnosed serologically, this disorder is often 
      responsive to immunosuppressant treatment. The objective of this review is to 
      educate clinicians on the challenges of diagnosis and management of this 
      disorder. MATERIALS AND METHODS: A review of the relevant literature on clinical 
      presentation, pathophysiology, and recommended management was conducted using a 
      PubMed search. Examination of the results identified articles published between 
      2007 and 2014. RESULTS: The literature highlights the importance of recognizing 
      early common signs and symptoms, which include hallucinations, seizures, altered 
      mental status, and movement disorders, often in the absence of fever. Although 
      the presence of blood and/or cerebrospinal fluid autoantibodies confirms 
      diagnosis, approximately 15% of patients have only positive cerebrospinal fluid 
      titers. Antibody detection should prompt a search for an underlying teratoma or 
      other underlying neoplasm and the initiation of first-line immunosuppressant 
      therapy: intravenous methylprednisolone, intravenous immunoglobulin, or 
      plasmapheresis, or a combination thereof. Second-line treatment with rituximab or 
      cyclophosphamide should be implemented if no improvement is noted after 10 days. 
      Complications can include behavioral problems (eg, aggression and insomnia), 
      hypoventilation, catatonia, and autonomic instability. Those patients who can be 
      managed outside an intensive care unit and whose tumors are identified and 
      removed typically have better rates of remission and functional outcomes. 
      CONCLUSION: There is an increasing need for clinicians of different specialties, 
      including psychiatrists, neurologists, oncologists, neurooncologists, 
      immunologists, and intensivists to become familiar with this disorder and its 
      potential complications. Remission can be optimized with prompt detection and 
      aggressive, collaborative treatment within a multidisciplinary team.
FAU - Mann, Andrea P
AU  - Mann AP
AD  - Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, USA.
FAU - Grebenciucova, Elena
AU  - Grebenciucova E
AD  - Department of Neurology, University of Chicago, Chicago, IL, USA.
FAU - Lukas, Rimas V
AU  - Lukas RV
AD  - Department of Neurology, University of Chicago, Chicago, IL, USA.
LA  - eng
GR  - UL1 TR000430/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Review
DEP - 20140701
PL  - New Zealand
TA  - Ther Clin Risk Manag
JT  - Therapeutics and clinical risk management
JID - 101253281
PMC - PMC4085332
OTO - NOTNLM
OT  - anti-NMDA receptor
OT  - complications
OT  - encephalitis
OT  - management
OT  - paraneoplastic
OT  - treatment
EDAT- 2014/07/26 06:00
MHDA- 2014/07/26 06:01
PMCR- 2014/07/01
CRDT- 2014/07/26 06:00
PHST- 2014/07/26 06:00 [entrez]
PHST- 2014/07/26 06:00 [pubmed]
PHST- 2014/07/26 06:01 [medline]
PHST- 2014/07/01 00:00 [pmc-release]
AID - tcrm-10-517 [pii]
AID - 10.2147/TCRM.S61967 [doi]
PST - epublish
SO  - Ther Clin Risk Manag. 2014 Jul 1;10:517-25. doi: 10.2147/TCRM.S61967. eCollection 
      2014.