title: N-methyl-D-aspartate receptor antibodies in post-herpes simplex virus encephalitis neurological relapse.
abstract: Herpes simplex virus encephalitis (HSVE) is a devastating condition that relapses, often with a chorea in children, despite adequate antiviral treatment. At relapse, evidence of viral replication is frequently absent, suggesting that the relapse may be immune-mediated. Seven children who had a neurological relapse following their initial encephalitis, identified from 20 cases of pediatric HSVE, were studied. Serum and/or cerebrospinal fluid (CSF) were tested for N-methyl-D-aspartate receptor (NMDAR) and other antibodies previously reported in central nervous system autoimmunity. Five of the 7 relapsing children had choreoathetosis; 2 of these were NMDAR antibody-positive, 2 were negative (1 with HSV-positive CSF), and 1 was not available for testing. An additional patient, who relapsed with cognitive regression but with no movement disorder, was also NMDAR antibody-positive. In 2 of the NMDAR antibody-positive patients who were treated at relapse and in 1 who was treated only after 10 years of having a relapsing encephalopathy, a beneficial response was observed. Neurological relapses after HSVE may frequently be immune-mediated, particularly in children with chorea. NMDAR antibodies are common, and immunotherapy may be beneficial.
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
authors.forename: Yael
authors.initials: Y
authors.lastname: Hacohen
authors.forename: Kumaran
authors.initials: K
authors.lastname: Deiva
authors.forename: Phillipa
authors.initials: P
authors.lastname: Pettingill
authors.forename: Patrick
authors.initials: P
authors.lastname: Waters
authors.forename: Ata
authors.initials: A
authors.lastname: Siddiqui
authors.forename: Pascale
authors.initials: P
authors.lastname: Chretien
authors.forename: Esse
authors.initials: E
authors.lastname: Menson
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lin
authors.forename: Marc
authors.initials: M
authors.lastname: Tardieu
authors.forename: Angela
authors.initials: A
authors.lastname: Vincent
authors.forename: Ming J
authors.initials: MJ
authors.lastname: Lim
mesh_terms: D000293:Adolescent; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000097:blood / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D002675:Child, Preschool; D020803:Encephalitis, Herpes Simplex / Q000097:blood / Q000276:immunology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D012008:Recurrence
chemical_list: D001323:Autoantibodies; D016194:Receptors, N-Methyl-D-Aspartate
keywords: N-methyl-D-aspartate (NMDA) receptor; choreoathetosis; encephalitis; herpes simplex virus; movement disorder; relapsing