[N-methyl-D-aspartate receptor antibody encephalitis: the Janus-faced disorder].

This article attempts to summarize the clinical features of this complex neuropsychiatric disorder with the aim to help its early recognition and to report the clinical course and the outcome of our six seropositive anti-NMDAR cases. The disease appears typically in young females and often combined with ovarian teratoma. However, the antibody production could develop without any malignancy. The course of the illness is usually monophasic, but 10% of the cases are relapsing. The anti-NMDAR encephalitis is the result of disturbed glutamatergic neurotransmission due to the internalization of the receptor-antibody complexes. The disease usually develops after a common viral infection, but recent data proved that anti-NMDAR encephalitis could also develop after herpes simplex virus-1 encephalitis. The Janus-faced clinical course of the disease is the obstacle of the early recognition. Psychiatric symptoms - like delusion, hallucination and agitation - dominate in the first, cortical phase of the illness, which are indistinguishable from the signs of primary psychosis. The true nature of the disease only reveals later, with the appearance of the basal ganglia territory and brainstem sings, such as perioral hyperkinesia and bradycardia. Further delays the diagnosis that the leading symptoms of the second phase could be interpreted as the side effects of the initial treatment. According to expert psychiatrists, the unusual dynamic of the psychotic symptoms and the lack of response to...
Source: Neuropsychopharmacologia Hungarica - Category: Psychiatry Tags: Neuropsychopharmacol Hung Source Type: research