title: N-methyl-d-aspartate (NMDA) receptor antibodies encephalitis mimicking an autistic regression.
abstract: Expressive dysphasia and mutism are common clinical features in children and adults with N-methyl-d-aspartate receptor antibodies (NMDAR-Ab) encephalitis, and are likely to result from NMDAR hypofunction. A prodromal loss of social and communication skills can typify that of an autistic regression, particularly when presenting under the age of 3 years. Here we describe two toddlers who presented with developmental regression, particularly of their social communication skills, mimicking an autistic regression, who were found to have NMDAR-Ab in the serum and cerebrospinal fluid. Although both patients had some other neurological features, they were subtle, which resulted in delayed diagnosis of NMDAR-Ab encephalitis. Importantly, immunotherapy was beneficial in both patients, with significant improvement of their language skills and behaviour.
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.|Paediatric Neuroscience, Evelina Children's Hospital @ Guys and St Thomas' NHS Foundation Trust, Kings Health Partners Academic Health Science Centre, London, UK.
authors.forename: Yael
authors.initials: Y
authors.lastname: Hacohen
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.|Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Sukhvir
authors.initials: S
authors.lastname: Wright
authors.affiliation: Paediatric Neuroscience, Evelina Children's Hospital @ Guys and St Thomas' NHS Foundation Trust, Kings Health Partners Academic Health Science Centre, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gadian
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Vincent
authors.affiliation: Paediatric Neuroscience, Evelina Children's Hospital @ Guys and St Thomas' NHS Foundation Trust, Kings Health Partners Academic Health Science Centre, London, UK.
authors.forename: Ming
authors.initials: M
authors.lastname: Lim
authors.affiliation: Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Evangeline
authors.initials: E
authors.lastname: Wassmer
authors.affiliation: Paediatric Neuroscience, Evelina Children's Hospital @ Guys and St Thomas' NHS Foundation Trust, Kings Health Partners Academic Health Science Centre, London, UK.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lin
mesh_terms: D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications / Q000175:diagnosis*; D001321:Autistic Disorder / Q000150:complications / Q000175:diagnosis*; D002675:Child, Preschool; D003147:Communication Disorders / Q000175:diagnosis* / Q000209:etiology; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male