title: Anti-N-methyl-D-aspartate receptor antibodies: a potentially treatable cause of encephalitis in the intensive care unit.
abstract: 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.
authors.affiliation: National Hospital for Neurology and Neurosurgery, and Institute of Neurology, University College London, London, UK.
authors.forename: Gerard
authors.initials: G
authors.lastname: Davies
authors.forename: Sarosh R
authors.initials: SR
authors.lastname: Irani
authors.forename: Cordelia
authors.initials: C
authors.lastname: Coltart
authors.forename: Gordon
authors.initials: G
authors.lastname: Ingle
authors.forename: Yogen
authors.initials: Y
authors.lastname: Amin
authors.forename: Christopher
authors.initials: C
authors.lastname: Taylor
authors.forename: Jeremy
authors.initials: J
authors.lastname: Radcliffe
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Hirsch
authors.forename: Robin S
authors.initials: RS
authors.lastname: Howard
authors.forename: Angela
authors.initials: A
authors.lastname: Vincent
authors.forename: Dimitri M
authors.initials: DM
authors.lastname: Kullmann
mesh_terms: 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
chemical_list: D001323:Autoantibodies; D016194:Receptors, N-Methyl-D-Aspartate