Anti-N-methyl-D-aspartate receptor antibodies: a potentially treatable cause of encephalitis in the intensive care unit.
OBJECTIVE
To report the occurrence of an unusual neurologic disorder requiring admission to the intensive care unit.


METHODS
Analysis of an observational cohort study of 31 patients with encephalitis admitted over a 4-yr period.


METHODS
Neurologic intensive care unit in a tertiary referral center.


METHODS
We identified N-methyl-D-aspartate receptor antibodies in six patients (two male and four female). All seropositive patients presented with a psychiatric prodrome, before developing seizures and obtundation requiring intensive care unit admission. They exhibited limb and truncal stereotypies and orofacial dyskinesias upon weaning sedation. Two patients had ovarian tumors.


METHODS
Patients were treated with sedation, antiepileptic drugs, and immunotherapy. One patient received a magnesium infusion and ketamine.


RESULTS
N-methyl-D-aspartate receptor antibodies were identified in serum samples by an immunofluorescent cell-based assay. Three patients made a good but slow recovery; two were left with severe neurologic deficits; and one died after return to the referring hospital. These patients accounted for approximately 20% of all patients admitted with encephalitis to this referral center.


CONCLUSIONS
N-methyl-D-aspartate receptor antibodies should be tested in patients with hyperkinetic encephalitis and neuropsychiatric prodrome admitted to the intensive care unit. The disorder is probably not rare and is potentially treatable.
Davies
Gerard
G
National Hospital for Neurology and Neurosurgery, and Institute of Neurology, University College London, London, UK.
Irani
Sarosh R
SR
Coltart
Cordelia
C
Ingle
Gordon
G
Amin
Yogen
Y
Taylor
Christopher
C
Radcliffe
Jeremy
J
Hirsch
Nicholas P
NP
Howard
Robin S
RS
Vincent
Angela
A
Kullmann
Dimitri M
DM
D000328:Adult; D001323:Autoantibodies / Q000276:immunology*; D020820:Dyskinesias / Q000209:etiology / Q000276:immunology; D004660:Encephalitis / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D005260:Female; D006801:Humans; D056747:Immunomodulation; D007362:Intensive Care Units; D008297:Male; D011618:Psychotic Disorders / Q000209:etiology / Q000276:immunology; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D012640:Seizures / Q000209:etiology / Q000276:immunology; D019956:Stereotypic Movement Disorder / Q000209:etiology / Q000276:immunology
D001323:Autoantibodies; D016194:Receptors, N-Methyl-D-Aspartate