title: Anti-NMDA-receptor antibody encephalitis in infants.
abstract: OBJECTIVE
  Anti-N-methyl-d-aspartate (NMDA) receptor antibody encephalitis is an autoimmune disorder manifesting subacutely with prominent aberrant movements and psychiatric symptoms. The clinical course is one of progressive clinical deterioration that can be halted and often reversed by early diagnosis and treatment. Patterns of presentation and etiology of anti-NMDA-receptor antibody encephalitis are dependent on age and can be challenging to recognize in very young children.
  
  
  METHODS
  Sequential clinical case observations of anti-NMDA-receptor antibody encephalitis presenting in very young children were examined over a year at a single tertiary pediatric institution. Cerebrospinal fluid confirmed anti-NMDA-receptor antibodies in two cases (a 21-month-old boy and a 29-month-old girl) that demonstrated either bizarre behavioral patterns or status epilepticus both associated with progressive deterioration. Once recognized, the clinical course was arrested and reversed by aggressive treatment with plasma exchange, immunoglobulin, and high dose IV steroids.
  
  
  CONCLUSIONS
  Infants with anti-NMDA-receptor antibody encephalitis can present with frank seizures or seizure mimics. Regardless, prompt recognition and aggressive treatment of anti-NMDA-receptor antibody encephalitis, while challenging, can quickly arrest deterioration and hasten recovery, thereby, limiting neurological morbidity.
authors.affiliation: University of Florida & Wolfson Children Hospital, Jacksonville, FL, USA.
authors.forename: Amr A
authors.initials: AA
authors.lastname: Matoq
authors.affiliation: Nemours Children Health System, Jacksonville, FL, USA; Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Rappoport
authors.affiliation: Nemours Children Health System, Jacksonville, FL, USA; Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Yiting
authors.initials: Y
authors.lastname: Yang
authors.affiliation: University of Florida & Wolfson Children Hospital, Jacksonville, FL, USA; Nemours Children Health System, Jacksonville, FL, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: O'Babatunde
authors.affiliation: Nemours Children Health System, Jacksonville, FL, USA.
authors.forename: Rubina
authors.initials: R
authors.lastname: Bakerywala
authors.affiliation: University of Florida & Wolfson Children Hospital, Jacksonville, FL, USA; Nemours Children Health System, Jacksonville, FL, USA; Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Raj D
authors.initials: RD
authors.lastname: Sheth
keywords: Anti-NMDA-receptor, anti-N-methyl-d-aspartate-receptor; Anti-NMDAR; Behavioral outburst; CSF, cerebrospinal fluid; Child; EEG, electroencephalogram; Encephalitis; Paraneoplastic syndrome; Psychosis