International Journal of General Medicine (Jan 2023)
Anti-NMDA Receptor Autoimmune Encephalitis: Diagnosis and Management Strategies
Abstract
Linda Nguyen, Cynthia Wang Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USACorrespondence: Linda Nguyen, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA, Tel +1-214-645-0136, Fax +1-214-645-8238, Email [email protected]: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most recognized form of autoimmune encephalitis. It is characterized by a constellation of neurologic and psychiatric features along with positive NMDAR antibody, which is more sensitive and specific in CSF than serum. All patients should be screened at least once for neoplasm, with ovarian teratoma being found in most tumor-related cases. In the acute phase, first-line immunotherapy, often a combination of high-dose steroids, immunoglobulins, and/or plasma exchange, is strongly recommended. When first-line therapy fails, escalation to second-line immunotherapy, particularly rituximab, can further improve outcomes and prevent relapses. In refractory cases, additional complementary immunotherapies, such as cyclophosphamide, bortezomib and/or tocilizumab may be considered. Relapses occur in 10– 30% of cases, mostly within the first two years from onset. Individuals should be followed up to determine if chronic maintenance therapy is required.Keywords: anti-NMDAR encephalitis, clinical features, immunotherapies, treatment options
