Encefalitis autoinmune mediada por anticuerpos contra el receptor n-metil-d-aspartato: Reporte de cuatro casos en Perú

Translated title of the contribution: 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 journalArticlepeer-review

1 Scopus citations

Abstract

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.

Translated title of the contributionAutoimmune encephalitis mediated by antibodies against the n-methyl-d-aspartate receptor: Report of four cases in Peru
Original languageSpanish
Pages (from-to)138-144
Number of pages7
JournalRevista Peruana de Medicina de Experimental y Salud Publica
Volume36
Issue number1
DOIs
StatePublished - Mar 2019

Bibliographical note

Funding Information:
El propósito de este reporte es resaltar que la encefalitis anti-NMDAR es una condición tratable que afecta a personas jóvenes y cuya omisión en el diagnóstico diferencial puede condicionar muerte o discapacidad evitable. Ante la presencia de un cuadro de crisis epilépticas farmacorresistentes de novo, estado epiléptico refractario, sobre todo si está asociado a síntomas psiquiátricos y compromiso cognitivo de instauración subaguda, se debe pensar en la encefalitis autoinmune anti-NMDAR. Finalmente, es importante incidir en la dificultad para realizar el diagnóstico en los hospitales del Ministerio de Salud debido a que el panel de anticuerpos de superficie neuronal no se encuentra disponible; por lo que contar con las pruebas diagnósticas apropiadas es una necesidad fundamental para mejorar el rendimiento diagnóstico y terapéutico en estos pacientes.

Publisher Copyright:
© 2019, Instituto Nacional de Salud. All rights reserved.

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

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