PMID- 32535682
OWN - NLM
STAT- MEDLINE
DCOM- 20210618
LR  - 20210618
IS  - 1432-1459 (Electronic)
IS  - 0340-5354 (Linking)
VI  - 267
IP  - 8
DP  - 2020 Aug
TI  - Refractory anti-NMDAR encephalitis successfully treated with bortezomib and 
      associated movements disorders controlled with tramadol: a case report with 
      literature review.
PG  - 2462-2468
LID - 10.1007/s00415-020-09988-w [doi]
AB  - Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a potentially fatal 
      autoimmune disease, characterized by autoantibody-mediated neurotransmission 
      impairment in multiple brain locations. The course of this condition often 
      comprises altered mental status, autonomic dysfunctions, refractory seizures and 
      hyperkinetic movement disorders. Available disease-modifying therapies include 
      corticosteroids, i.v. immunoglobulins, plasma exchange, rituximab and 
      cyclophosphamide. In a subgroup of patients not responding to B-cell depletion, 
      bortezomib, a proteasome inhibitor, has shown promising evidence of efficacy. The 
      time course of recovery from acute phase may be very slow (weeks/months), and 
      only few data are available in literature about the concurrent management of 
      encephalitis-associated movement disorders. We report a case of severe anti-NMDAR 
      encephalitis in a 29-year-old woman, not responsive to first- and second-line 
      treatments, with persistent involuntary motor manifestations. Starting three 
      months after symptom onset, four cycles of bortezomib have been administered; 
      subsequently we observed a progressive improvement of neurological status. 
      Meanwhile, motor manifestations were controlled after the administration of 
      tramadol, a non-competitive NMDA receptor antagonist.
FAU - Lazzarin, Serena Marita
AU  - Lazzarin SM
AD  - Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
AD  - Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Vabanesi, Marco
AU  - Vabanesi M
AUID- ORCID: 0000-0002-8283-7079
AD  - Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
AD  - Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Cecchetti, Giordano
AU  - Cecchetti G
AUID- ORCID: 0000-0002-6544-410X
AD  - Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
AD  - Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Fazio, Raffaella
AU  - Fazio R
AD  - Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Fanelli, Giovanna Franca
AU  - Fanelli GF
AD  - Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Volonte, Maria Antonietta
AU  - Volonte MA
AD  - Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Genchi, Angela
AU  - Genchi A
AD  - Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Giordano, Antonino
AU  - Giordano A
AUID- ORCID: 0000-0002-3685-8311
AD  - Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Martinelli, Vittorio
AU  - Martinelli V
AUID- ORCID: 0000-0002-5987-5739
AD  - Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
FAU - Colombo, Sergio
AU  - Colombo S
AD  - General Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, 
      Italy.
FAU - Beccaria, Paolo
AU  - Beccaria P
AD  - General Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, 
      Italy.
FAU - Mucci, Milena
AU  - Mucci M
AD  - General Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, 
      Italy.
FAU - Peccatori, Jacopo
AU  - Peccatori J
AD  - Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific 
      Institute, Milan, Italy.
FAU - Filippi, Massimo
AU  - Filippi M
AUID- ORCID: 0000-0002-5485-0479
AD  - Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. 
      filippi.massimo@hsr.it.
AD  - Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. 
      filippi.massimo@hsr.it.
AD  - Neuroimaging Research Unit, Institute of Experimental Neurology, Division of 
      Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, 
      Milan, Italy. filippi.massimo@hsr.it.
AD  - Vita-Salute San Raffaele University, Milan, Italy. filippi.massimo@hsr.it.
FAU - Minicucci, Fabio
AU  - Minicucci F
AD  - Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20200613
PL  - Germany
TA  - J Neurol
JT  - Journal of neurology
JID - 0423161
RN  - 39J1LGJ30J (Tramadol)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 69G8BD63PP (Bortezomib)
SB  - IM
EIN - J Neurol. 2021 Feb;268(2):741-742. PMID: 33417007
MH  - Adult
MH  - *Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications/drug therapy
MH  - Bortezomib/therapeutic use
MH  - Female
MH  - Humans
MH  - *Movement Disorders/drug therapy/etiology
MH  - Rituximab
MH  - *Tramadol
OTO - NOTNLM
OT  - Anti-NMDAR encephalitis
OT  - Autoimmune encephalitis
OT  - Bortezomib
OT  - EEG
OT  - Movement disorders
EDAT- 2020/06/15 06:00
MHDA- 2021/06/22 06:00
CRDT- 2020/06/15 06:00
PHST- 2020/04/16 00:00 [received]
PHST- 2020/06/09 00:00 [accepted]
PHST- 2020/06/08 00:00 [revised]
PHST- 2020/06/15 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2020/06/15 06:00 [entrez]
AID - 10.1007/s00415-020-09988-w [pii]
AID - 10.1007/s00415-020-09988-w [doi]
PST - ppublish
SO  - J Neurol. 2020 Aug;267(8):2462-2468. doi: 10.1007/s00415-020-09988-w. Epub 2020 
      Jun 13.