title: Auto-immune anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis: three case reports.
abstract: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a recently identified auto-immune disorder characterised by severe memory deficit, a decreased level of consciousness, seizures, autonomic dysfunction and movement disorders. Three girls with the disorder are reported; they were aged 4 years, 5 years and 10 months. The 10-month-old infant who is one of the youngest patients reported with anti-NMDAR encephalitis worldwide, had MRI features suggestive of herpes simplex encephalitis (known to trigger anti-NMDAR encephalitis), but CSF PCR for herpes simplex was negative. All the patients presented with seizures, behavioural change, regression of speech, dystonia and choreo-athetosis. Anti-NMDAR antibodies were detected in all patients' sera and cerebrospinal fluid (CSF). Intravenous immunoglobulin, corticosteroids and rituximab were administered at different intervals. Cases 1 and 2 made a full recovery, but case 3 has mild motor and speech delay. Patients who present with encephalopathy, seizures and movement disorders should be tested for anti-NMDAR antibodies in serum and CSF in addition to being screened for herpes simplex encephalitis.
authors.affiliation: a Division of Pediatric Neurology.
authors.forename: Fahad A
authors.initials: FA
authors.lastname: Bashiri
authors.affiliation: b Pediatric Rheumatology, Department of Pediatrics.
authors.forename: Abdulrahman A
authors.initials: AA
authors.lastname: Al-Rasheed
authors.affiliation: a Division of Pediatric Neurology.
authors.forename: Saeed M
authors.initials: SM
authors.lastname: Hassan
authors.affiliation: a Division of Pediatric Neurology.
authors.forename: Muddathir H A
authors.initials: MHA
authors.lastname: Hamad
authors.affiliation: a Division of Pediatric Neurology.
authors.forename: Heba Y
authors.initials: HY
authors.lastname: El Khashab
authors.affiliation: a Division of Pediatric Neurology.
authors.forename: Amal Y
authors.initials: AY
authors.lastname: Kentab
authors.affiliation: c Division of Neuroradiology, Department of Radiology, College of Medicine and King Khalid University Hospital , King Saud University , Riyadh , Saudi Arabia.
authors.forename: Fahad B
authors.initials: FB
authors.lastname: AlBadr
authors.affiliation: a Division of Pediatric Neurology.
authors.forename: Mustafa A
authors.initials: MA
authors.lastname: Salih
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D001323:Autoantibodies / Q000097:blood*; D001921:Brain / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007223:Infant; D008279:Magnetic Resonance Imaging; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D000069283:Rituximab / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001323:Autoantibodies; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D016194:Receptors, N-Methyl-D-Aspartate; D000069283:Rituximab
keywords: Anti-NMDAR encephalitis; Auto-antibodies; Children; Immunomodulation therapy; Movement disorder