title: Role of Autoantibodies to N-Methyl-d-Aspartate (NMDA) Receptor in Relapsing Herpes Simplex Encephalitis: A Retrospective, One-Center Experience.
abstract: Post-herpes simplex virus encephalitis relapses have been recently associated with autoimmunity driven by autoantibodies against N-methyl-d-aspartate (NMDA) receptors. Because it offers different treatment options, determination of this condition is important. Between 2011 and 2014, 7 children with proven diagnosis of herpes simplex virus encephalitis were identified in a university hospital of Istanbul. Two patients had neurologic relapse characterized mainly by movement disorders 2 to 3 weeks after initial encephalitis. The first patient received a second 14 days of acyclovir treatment together with antiepileptic drugs and left with severe neurologic sequelae. The second patient was found to be NMDA receptors antibody positive in the cerebrospinal fluid. She was treated with intravenous immunoglobulin and prednisolone. She showed substantial improvement, gradually regaining lost neurologic abilities. Post-herpes simplex virus encephalitis relapses may frequently be immune-mediated rather than a viral reactivation, particularly in children displaying movement disorders like choreoathetosis. Immunotherapy may provide benefit for this potentially devastating condition, like the case described in this report.
authors.affiliation: Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Sutcu
authors.affiliation: Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey hacergunakturk@gmail.com.
authors.forename: Hacer
authors.initials: H
authors.lastname: Akturk
authors.affiliation: Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Ayper
authors.initials: A
authors.lastname: Somer
authors.affiliation: Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Tatli
authors.affiliation: Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Selda Hancerli
authors.initials: SH
authors.lastname: Torun
authors.affiliation: Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Edibe Pembegul
authors.initials: EP
authors.lastname: Yıldız
authors.affiliation: Department of Pediatric Intensive Care, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Guntulu
authors.initials: G
authors.lastname: Şık
authors.affiliation: Department of Pediatric Intensive Care, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Agop
authors.initials: A
authors.lastname: Citak
authors.affiliation: Department of Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Agacfidan
authors.affiliation: Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Nuran
authors.initials: N
authors.lastname: Salman
mesh_terms: D000293:Adolescent; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000188:drug therapy / Q000503:physiopathology; D001323:Autoantibodies / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D020803:Encephalitis, Herpes Simplex / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D001323:Autoantibodies; D016194:Receptors, N-Methyl-D-Aspartate
keywords: NMDA receptor autoantibodies; autoimmunity; herpes encephalitis; relapsing herpes encephalitis