title: First reported cases of anti-NMDA receptor encephalitis in Vietnamese adolescents and adults.
abstract: BACKGROUND
  Anti-NMDA receptor encephalitis is increasingly recognised as an important differential diagnosis in patients with encephalitis of unknown aetiology. We report the first case series of patients diagnosed in Vietnam.
  
  
  METHODS
  Samples of CSF from patients with presumed encephalitis but negative microbiological investigations, who exhibited dyskinesia, autonomic instability or psychosis were tested for antibodies against the NR1 subunit of the glutamate (type-NMDA) receptor using an indirect immunofluorescence assay.
  
  
  RESULTS
  Of 99 patients admitted with all-cause encephalitis over an 18month period, 9.1% (n=9 patients, 5 female, median age 28years) had confirmed NMDAR encephalitis. All patients were admitted from one mental health hospital, and the incidence may therefore be an underestimate. Common features included reduction in speech (n=9), catatonia (n=9), convulsions (n=7), dyskinesia (n=9), rigidity (n=9) and autonomic dysfunction (n=7). Aside from a modest lymphocytic pleocytosis, routine CSF analysis was usually normal. No female patient had ovarian teratoma detected by abdominal ultrasound. Most patients were treated with high dose corticosteroids, and one patient received intravenous immunoglobulin. The median duration of hospitalization was 75days and no patient died during admission.
  
  
  CONCLUSIONS
  Anti-NMDA receptor encephalitis is an important differential diagnosis to consider for patients presenting with acute onset psychiatric symptoms, who develop ensuing seizures, movement or autonomic disorder in Vietnam. A stronger evidence base for management and access to second line immunotherapy agents may help to reduce morbidity from this disease.
authors.affiliation: Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam. Electronic address: mainth@oucru.org.
authors.forename: Mai
authors.initials: M
authors.lastname: Nguyen Thi Hoang
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam.
authors.forename: Phu
authors.initials: P
authors.lastname: Nguyen Hoan
authors.affiliation: Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.
authors.forename: Tan
authors.initials: T
authors.lastname: Le Van
authors.affiliation: Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.
authors.forename: Angela
authors.initials: A
authors.lastname: McBride
authors.affiliation: Pham Ngoc Thach Medical University, Ho Chi Minh City, Viet Nam.
authors.forename: Nghia
authors.initials: N
authors.lastname: Ho Dang Trung
authors.affiliation: Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.
authors.forename: Thanh
authors.initials: T
authors.lastname: Tran Tan
authors.affiliation: Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.
authors.forename: Hong
authors.initials: H
authors.lastname: Nguyen Thi Thu
authors.affiliation: Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Heemskerk
authors.affiliation: Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Day
authors.affiliation: Department of Clinical Neurology, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Vincent
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam.
authors.forename: Chau
authors.initials: C
authors.lastname: Nguyen Van Vinh
authors.affiliation: Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK.
authors.forename: Guy
authors.initials: G
authors.lastname: Thwaites
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000134:cerebrospinal fluid* / Q000523:psychology / Q000628:therapy*; D001323:Autoantibodies / Q000134:cerebrospinal fluid; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001921:Brain / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005500:Follow-Up Studies; D006801:Humans; D007167:Immunotherapy; D007902:Length of Stay; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology; D016896:Treatment Outcome; D014744:Vietnam; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D001323:Autoantibodies; D015415:Biomarkers; C409466:NR1 NMDA receptor; D018696:Neuroprotective Agents; D016194:Receptors, N-Methyl-D-Aspartate
keywords: Adult; Anti-NMDA; Encephalitis; Receptor; Vietnam