Autoimmune encephalitis mediated by antibodies against the n-methyl-d-aspartate receptor: Report of four cases in Peru

Henry Palomino-Lescano, Darwin Segura-Chávez, Darko Quispe-Orozco, Sheila Castro-Suarez, Walter De la Cruz, Willy Zapata-Luyo, José Delgado-Ríos, Juan Cam, Marcela Alvarado-Morales, Lippmann Paredes-Carcasi, Iván Cornejo-Herrera, María Meza-Vega

Research output: Contribution to journalArticle

Abstract

© 2019, Instituto Nacional de Salud. All rights reserved. Autoimmune encephalitis with antibodies against the N-methyl-D-aspartate receptor (anti-NMDAR) is a disorder mediated by antibodies against neural surface antigens, whose early diagnosis and timely treatment improve the prognosis of the disease. Four cases with the definitive diagnosis of autoimmune encephalitis by anti-NMDAR are presented, treated at the National Institute of Neurological Sciences in Lima-Peru. All patients had epileptic seizures and three cases developed a refractory epileptic state. In addition, three patients presented neuropsychiatric alterations, dyskinesias, and dysautonomia. Two cases required ventilatory support. All presented an abnormal electroencephalogram; two cases had pleocytosis in cerebrospinal fluid, and only one showed brain abnormalities on MRI. Regarding treatment, all patients received methylprednisolone immunotherapy and only two of them required plasma exchange for an ineffective response to corticosteroid treatment. After 12 months of hospital discharge, three patients were free of epileptic seizures and only one case did not achieve functional independence. These cases show that anti-NMDAR encephalitis is a treatable condition and its early recognition together with appropriate treatment (immunotherapy/plasmapheresis) are essential for a favorable evolution.
Original languageAmerican English
Pages (from-to)138-144
Number of pages7
JournalRevista Peruana de Medicina Experimental y Salud Publica
DOIs
StatePublished - 1 Mar 2019
Externally publishedYes

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    Palomino-Lescano, H., Segura-Chávez, D., Quispe-Orozco, D., Castro-Suarez, S., De la Cruz, W., Zapata-Luyo, W., Delgado-Ríos, J., Cam, J., Alvarado-Morales, M., Paredes-Carcasi, L., Cornejo-Herrera, I., & Meza-Vega, M. (2019). Autoimmune encephalitis mediated by antibodies against the n-methyl-d-aspartate receptor: Report of four cases in Peru. Revista Peruana de Medicina Experimental y Salud Publica, 138-144. https://doi.org/10.17843/rpmesp.2019.361.3936