Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

Autoantibody Associated Disorders of the CNS in Children: The List Keeps Growing

Seshia, SS and Dale, RC and Kirkham, FJ (2012) Autoantibody Associated Disorders of the CNS in Children: The List Keeps Growing. CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES , 39 (2) 129 - 131.

The expanding spectrum of clinically-distinctive, immunotherapy-responsive autoimmune encephalopathies

Arquivos de Neuro-Psiquiatria
Print version ISSN 0004-282X
Arq. Neuro-Psiquiatr. vol.70 no.4 S?o Paulo Apr. 2012

http://dx.doi.org/10.1590/S0004-282X2012000400015

O espectro em expans?o das encefalopatias autoimunes clinicamente distintas e que respondem ? imunoterapia
Sarosh R IraniI; Angela VincentII
IDPhil MRCP; Nuffield Department of Clinical Neurosciences, West Wing, John Radcliffe Hospital, Oxford, UK
IIFRS FRCPath; Nuffield Department of Clinical Neurosciences, West Wing, John Radcliffe Hospital, Oxford, UK
[snip]
CONCLUSIONS

In summary, there is a growing number of CNS-disorders which are associated with potentially pathogenic autoantibodies. Many of these antibodies are directed against CNS receptors (e.g. NMDA, glycine, AMPA, and GABAB), but also non-ion channel proteins (LGI1, CASPR2 and contactin-2) are being established as antigenic targets. As shown in the Table, consistent and distinctive disease features appear to segregate with the individual antibodies. In the established syndromes, these clinical features are sufficiently characteristic to be highly predictive of an underlying antibody. As early treatments offer optimal outcomes, confident clinical recognition should be encouraged. The ongoing expansion in the number of autoantibody associated clinical syndromes is likely to continue in the coming years.

[Anti-NMDA-receptor encephalitis: a new axis-III disorder in the differential diagnosis of childhood disintegrative disorder, early onset schizophrenia and late onset autism].

Tijdschr Psychiatr. 2012;54(5):475-9.
[Anti-NMDA-receptor encephalitis: a new axis-III disorder in the differential diagnosis of childhood disintegrative disorder, early onset schizophrenia and late onset autism].
[Article in Dutch]
Creten C, van der Zwaan S, Blankespoor RJ, Maatkamp A, Klinkenberg S, van Kranen-Mastenbroek VH, Nicolai J, Dhossche DM, van Os J, Schieveld JN.
Source

Psychiatrie & Psychologie, Masstricht.
Abstract

Childhood disintegrative disorder (CDD), early onset schizophrenia (EOS), and late onset autism (LOA) often follow a similar course: initially, development is normal, then there is a sudden neuropsychiatric deterioration of social interaction and communication skills, which is combined with a decline in intelligence and reduction in daily activities. A 9-year-old boy was admitted to the paediatric ward with acute onset of secondary epileptic seizures. It was not long until the boy's symptoms resembled that of patients with cdd, eos and loa. Intensive tests led to the diagnosis of anti-NMDA-receptor encephalitis. Anti-NMDA-receptor encephalitis should be regarded as a possible organic cause underlying the syndromal presentation of CDD, EOS and LOA.

PMID:
22588963
[PubMed - indexed for MEDLINE]

Free full text

The Rehabilitation of Children with Anti?N-methyl-D-aspartate?Receptor Encephalitis: A Case Series

American Journal of Physical Medicine & Rehabilitation:
May 2012 - Volume 91 - Issue 5 - p 435?441
doi: 10.1097/PHM.0b013e3182465da6
Case Series

Houtrow, Amy J. MD, MPH; Bhandal, Manjit; Pratini, Napala R.; Davidson, Loren MD; Neufeld, Jacob A. MD, MSPH
Collapse Box
Abstract

ABSTRACT: Anti?N-methyl-D-aspartate (NMDA)?receptor encephalitis is a serious, complex, and potentially fatal disease in children. Children with this condition frequently present with altered mental status, rapid functional deterioration, and seizures. Despite aggressive treatment with immune therapy such as corticosteroids, intravenous immunoglobin, and plasmapheresis, children often need extensive rehabilitative services and can be left with lasting deficits. In this case series, we report on six known consecutive pediatric cases of N-methyl-D-aspartate?receptor antibody encephalitis in Northern California requiring comprehensive inpatient rehabilitation. The children presented with a variety of symptoms and had waxing and waning clinical courses. All children progressed well through their rehabilitation programs but were discharged home with persistent functional deficits. At follow-up, all but one child had lasting deficits. Because of the complicated management and extensive rehabilitation needs of children with anti?N-methyl-D-aspartate?receptor encephalitis, physiatrists and other rehabilitation providers should be knowledgeable about this complex condition.

? 2012 Lippincott Williams & Wilkins, Inc.

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

Oakland doctors treat girl's mysterious seizures

Thursday, June 28, 2012

Carolyn Johnson
More: Bio, E-mail, Facebook, Twitter, News Team

OAKLAND, Calif. (KGO) -- A 2-year-old girl is home with her family after battling a mysterious disease that forced her into a coma. The illness was finally diagnosed by doctors at Children's Hospital in Oakland.
[snip]
Finally, the sample sent to Spain confirmed the diagnosis. Gillian, just 2 years old, had a recently discovered form of encephalitis. So new, it had only been described a few years before she was born.

The encephalitis is known as anti-N.M.D.A.R. Doctors at Children's Hospital say it's caused by dangerous antibodies created by the patient's own immune systems.

"The antibody then crosses into the brain and attacks the brain," Petru said. ..

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

I don't see NMDAR specifically listed here, but this is a case of some sort of autoimmune encephalitis:

A Social Media Campaign Helped This Girl Get Insurance To Cover A $60K Medical Treatment

Zachry Floro | Jun. 13, 2012, 1:46 PM
[snip]
About six months ago, Ellen Whittington was diagnosed with autoimmune encephalitis, a rare disease that affects the brain and causes the loss of motor skills and memory...

Read more: http://www.businessinsider.com/ellen...#ixzz1zXViUoAU

I saw a comment posted to the Facebook link referenced in the above article about another girl who is being treated for anti-NMDAR encephalitis and her mother has a Facebook page about that:

Anti-NMDA Receptor Encephalitis - My Daughter Allie's Diagnosis

The next article is about a young mother with autoimmune encephalitis in Australia:

Brave Werrington mum still manages a laugh

Health
7 Jun 12 @ 05:00am by BRAD EARL
[snip]
Mrs Levy, of Werrington, passed out on Christmas Day and was admitted to Nepean Hospital suffering mysterious seizures.

After being put into an induced coma for nearly eight weeks and transferred to Westmead Hospital ICU, doctors finally diagnosed paraneoplastic limbic encephalitis; the antibodies in Mrs Levy?s blood attack her brain tissue and cause the violent seizures.

So rare is the condition that doctors struggle to provide clear treatment plans and the long-term prognosis is uncertain....

That isn't what anti-NMDAR encephalitis is commonly called, but it is one of several possibilities covered by the term:

Paraneoplastic limbic encephalitis

Also I saw some news that Susannah Cahalan, the reporter at the New York Post who recovered from anti-NMDAR E and joined forces with her doctors to educate the public and health care providers about the illness, (see first post in this thread), has a book set to release in November of this year:

Brain On Fire

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

21 yr-old man in New Hampshire, USA:

http://www.sentinelsource.com/life_and_style/health_fitness/stunned-gilsum-man-stricken-with-rare-illness/article_e57b97ba-c61f-5bef-a426-61764f01c7d7.html

Posted: Wednesday, August 8, 2012 12:15 pm | Updated: 11:51 am, Wed Aug 8, 2012.

By NICOLE S. COLSON Sentinel Staff | 0 comments

Eric Timmons got into his car at home in Gilsum the night of April 2 to head off and work the third shift at McDonald?s in Keene. His father, David Timmons, waved goodbye to his son. Eric never made it to work.
[snip]
Not only is the condition rare, Eric?s case is even more unusual because 80 percent of patients with the illness are women.

Dr. Camilo E. Fadul, a neuro-oncologist at Dartmouth-Hitchcock in Lebanon, is Eric?s doctor. Eric is only the third case diagnosed in Lebanon...

http://www.jmedicalcasereports.com/c...1/224/abstract

Case report
Anti-N-methyl-D-aspartate receptor encephalitis presenting with acute psychosis in a preteenage girl: a case report Paraskevi Maggina, Mersini Mavrikou, Stavroula Karagianni, Chrysanthi L Skevaki, Antigoni Triantafyllidou, Constantinos Voudris, Eustathia Katsarou, Lela Stamogiannou and Sotiria Mastroyianni


Journal of Medical Case Reports 2012, 6:224 doi:10.1186/1752-1947-6-224
Published: 30 July 2012 Abstract (provisional)

Introduction

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a rare, newly defined autoimmune clinical entity that presents with atypical clinical manifestations. Most patients with anti-N-methyl-D-aspartate receptor encephalitis develop a progressive illness from psychosis into a state of unresponsiveness, with catatonic features often associated with abnormal movements and autonomic instability. This is the first report of anti-N-methyl-D-aspartate receptor encephalitis in a Greek pediatric hospital.
Case presentation

An 11-year-old Greek girl presented with clinical manifestations of acute psychosis. The differential diagnosis included viral encephalitis. The presence of a tumor usually an ovarian teratoma, a common clinical finding in many patients, was excluded. Early diagnosis and prompt immunotherapy resulted in full recovery up to one year after the initial diagnosis.
Conclusion

Acute psychosis is a rare psychiatric presentation in children, diagnosed only after possible organic syndromes that mimic acute psychosis are excluded, including anti-N-methyl-D-aspartate receptor receptor encephalitis. Pediatricians, neurologists and psychiatrists should consider this rare clinical syndrome, in order to make an early diagnosis and instigate appropriate treatment to maximize neurological recovery.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

? 2012 BioMed Central Ltd unless otherwise stated. Part of Springer Science+Business Media.

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://jcn.sagepub.com/content/early...38099.abstract

Published online before print March 8, 2012, doi: 10.1177/0883073812438099 J Child Neurol March 8, 2012 0883073812438099
Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis Mimicking a Primary Psychiatric Disorder in an Adolescent

S?bastien Lebon,
Claire Mayor-Dubois, PhD
Irina Popea, MD
Claudia Poloni, MD
Nalini Selvadoray, MD
Alain Gumy, MD
Eliane Roulet-Perez, MD

Abstract

Anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis likely has a wider clinical spectrum than previously recognized. This article reports a previously healthy 16-year-old girl who was diagnosed with anti-NMDA receptor encephalitis 3 months after onset of severe depression with psychotic features. She had no neurological manifestations, and cerebral magnetic resonance imaging (MRI) was normal. Slow background on electroencephalogram and an oligoclonal band in the cerebrospinal fluid prompted the search for anti-NMDA receptor antibodies. She markedly improved over time but remained with mild neuropsychological sequelae after a trial of late immunotherapy. Only a high index of suspicion enables recognition of the milder forms of the disease masquerading as primary psychiatric disorders.

http://journals.lww.com/pidj/Abstrac...alitis.25.aspx

Pediatric Infectious Disease Journal:
February 2012 - Volume 31 - Issue 2 - p 202?204
doi: 10.1097/INF.0b013e31823d52eb
Brief Reports
Anti-N-methyl D-Aspartate Receptor Encephalitis Mimics Viral Encephalitis

Bseikri, Mustafa R. MD*; Barton, Jubilee R. MD?,?; Kulhanjian, Julie A. MD?; Dalmau, Josep MD, PhD?,‖; Cohen, Ronald A. MD**; Glaser, Carol A. DVM, MPVM, MD??,??; Roy-Burman, Arup MD?,?

Abstract

We describe the clinical courses of 3 children with a psychochoreiform encephalitis associated with anti-N-methyl D-aspartate receptor autoantibodies. These cases, including the most severely medically complicated survivor to date, illustrate the challenges of diagnosis, supportive care, and immune-modulating therapy. Clinical and laboratory features are similar to those of viral encephalitis, and the condition is often reversible with appropriate diagnosis and treatment.

? 2012 Lippincott Williams & Wilkins, Inc.

The case below is unusual. A 50-yr-old man had a head contusion followed by a tonic-clonic seizure and the lesions were seen. The next day he had status epilepticus. He was treated with high dose IV methylprednisolone and somewhat recovered. The only finding after a thorough work-up were the NMDAR antibodies. He had no further treatment but fully recovered in 2 months with no relapse in 16 months.

http://www.springerlink.com/content/75670n505r022535/

Neurological Sciences
2012, DOI: 10.1007/s10072-012-1169-8

Published in partnership with
Logo

the Italian Neurological Society

Letter to the Editor
Anti-NMDAR encephalitis preceded by dura mater lesions

Hidekazu Suzuki, Mari Kitada, Shuichi Ueno, Keiko Tanaka and Susumu Kusunoki

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

Full article in German:
http://www.aerztezeitung.de/medizin/...usknipsen.html

Google translation:

Autoimmune encephalitis
If falling Edison antibody memory

Mental disorders and memory loss - a few years ago, the anti-NMDAR encephalitis described in young women. It seems, however, to be more common than previously thought.

By Thomas Mueller
?rzte Zeitung, 10.10.2012
Wenn Antik?rper das Ged?chtnis ausknipsen

Derivation of an EEG, in young women may underlie neuropsychiatric symptoms, an anti-NMDAR encephalitis.

? Klaro

HAMBURG. A student withdraws suddenly becomes passive, depressed, does not with the school. Here are uncontrollable seizures.

Another suddenly has major memory problems may call on demand any three different colors and remember any new words.

Which doctor would suspect that he with a corticosteroid both girls quickly and completely brings into remission?

On the neurologist Congress in Hamburg lecturer Christian Bien presented by Epilepsy Center Bethel case studies of patients with a neurological disease that may be not so rare as first thought: the anti-NMDA receptor antibody encephalitis, short anti-NMDAR encephalitis.

Five years ago, it was described in a first publication in twelve patients aged between 14 and 44 years, all had a teratoma.

Since forming germ cell tumors and nerve cells, it is believed that this trigger the autoimmune reaction against the NMDA receptor.

Meanwhile, the Bien, the disease had been reported in over 400 patients, of whom the majority had no tumors.
Depression, hallucinations, memory loss

Also, the spectrum of symptoms has shifted somewhat. Typical is still a combination of mental and neurological symptoms in previously mostly unremarkable young women.

These symptoms include apathy, depression, anxiety, hallucinations, amnesia, memory loss, autonomic dysfunction, dyskinesia, seizures and loss of consciousness.

Meanwhile, however, and more often less severe cases detected, in which there is no clouding of consciousness and MRI abnormalities.

Even a life-threatening hypoventilation - beginning even a major problem - will now rarely observed.

Also affects not only women: About 10 to 20 percent of patients are male. Most often, the disease occurs at the end of the second and beginning of the third decade of life. ...

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

Suannah Cahalan's book, (see first post in thread) is out and is getting good reviews.

http://www.scientificamerican.com/ar...-brain-on-fire

Recommended: Brain on Fire
By Anna Kuchment
Brain on Fire: My Month of Madness
by Susannah Cahalan

Interview with the author here:

http://www.wbur.org/npr/165115921/a-...-brain-on-fire

A Young Reporter Chronicles Her 'Brain On Fire'
November 14, 2012

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

First case of ANMDARE reported in Greece:

http://www.ncbi.nlm.nih.gov/pubmed/22846610

J Med Case Rep. 2012 Jul 30;6(1):224. doi: 10.1186/1752-1947-6-224.
Anti-N-methyl-D-aspartate receptor encephalitis presenting with acute psychosis in a preteenage girl: a case report.
Maggina P, Mavrikou M, Karagianni S, Skevaki CL, Triantafyllidou A, Voudris C, Katsarou E, Stamogiannou L, Mastroyianni S.
Source

1st Department of Pediatrics, "P & A Kyriakou" Children's Hospital, Athens, Greece.

First case of ANMDARE in Sri Lanka reported:

http://www.ncbi.nlm.nih.gov/pubmed/22772791

Ceylon Med J. 2012 Jun;57(2):90-1. doi: 10.4038/cmj.v57i2.4466.
Treatment-responsive, reversible, autoimmune encephalitis in a child.
Wanigasinghe J, Chang T, Vincent A.
Source

Department of Paediatrics, Faculty of Medicine, University of Colombo, Sri Lanka

Full reports are available for free via the links.

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

She collapsed 14 months ago at age 16. Initially the cause was thought to be a stroke or meningitis since "she had a rash and she couldn't speak without slurring and she couldn't move one side." Doctors now think it could either be anti-NMDA receptor encephalitis or Sydenham's chorea, but apparently tests haven't confirmed the cause. The symptoms are cycling and include hallucinations, epileptic-like movements and severe memory problems.

http://www.thisissouthwales.co.uk/Sw...ail/story.html

Swansea couple is desperately seeking a diagnosis of their daughter's mysterious illness
Wednesday, December 19, 2012
South Wales Evening Post
By geraint thomas

A SWANSEA couple is desperately seeking a diagnosis of their daughter's mysterious illness, which has seen the once independent teenager become as dependent as a toddler over the past year...

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430387/

J Neurosci. Author manuscript; available in PMC 2013 February 8.
Published in final edited form as:
J Neurosci. 2012 August 8; 32(32): 11082?11094.
doi: 10.1523/JNEUROSCI.0064-12.2012
PMCID: PMC3430387
NIHMSID: NIHMS400317
Anti-NMDA Receptor Encephalitis Antibody Binding Is Dependent on Amino Acid Identity of a Small Region Within the GluN1 Amino Terminal Domain
Amy J. Gleichman,1,2 Lynn A. Spruce,3 Josep Dalmau,1,4 Steven H. Seeholzer,3 and David R. Lynch1,2
Author information ► Copyright and License information ►
The publisher's final edited version of this article is available free at J Neurosci
Go to:
Abstract

Anti-NMDA receptor (NMDAR) encephalitis is a newly identified autoimmune disorder that targets NMDARs, causing severe neurological symptoms including hallucinations, psychosis, and seizures, and may result in death (Dalmau et al., 2008). However, the exact epitope to which these antibodies bind is unknown. A clearly defined antigenic region could provide more precise testing, allow for comparison of immunogenicity between patients to explore potential clinically relevant variations, elucidate the functional effects of antibodies, and make patients? antibodies a more effective tool with which to study NMDAR function. Here, we use human cerebrospinal fluid to explore the antigenic region of the NMDAR. We created a series of mutants within the amino terminal domain of GluN1 that change patient antibody binding in transfected cells in stereotyped ways. These mutants demonstrate that the N368/G369 region of GluN1 is crucial for the creation of immunoreactivity. Mass spectrometry experiments show that N368 is glycosylated in transfected cells and rat brain regions; however, this glycosylation is not directly required for epitope formation. Mutations of residues N368/G369 change the closed time of the receptor in single channel recordings; more frequent channel openings correlates with the degree of antibody staining, and acute antibody exposure prolongs open time of the receptor. The staining pattern of mutant receptors is similar across subgroups of patients, indicating consistent immunogenicity, although we have identified one region that has a variable role in epitope formation. These findings provide tools for detailed comparison of antibodies across patients and suggest an interaction between antibody binding and channel function.
[snip]
Discussion
[snip]
Also, while the present work provides strong evidence that the epitope is the same across patients with tumors and those without, how the autoimmune response is generated in the latter group is unclear. There remain a large number of potential triggers for the initiation of the immune process; as this disorder becomes more widely identified and studied, there should be significant advances in this area.[/B] Because recovery rates are much greater when the tumor is found and removed (Dalmau et al., 2008), determining the immunological trigger must be a priority in future work. The tools developed here should help in that process....

Full text at link.

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://www.thestar.co.uk/news/health...life-1-5888507

?Thank you for saving my life?
by Richard Blackledge, Health Reporter

Published on the 26 July 2013 06:00


A man who spent months in a coma battling a life-threatening brain disease which struck while he was on holiday in Greece is holding a fundraiser to thank the medics who saved him.

Daniel Carroll, aged 53, from Sothall, was enjoying a break in Crete with wife Marie, 49, when he developed a rare condition called anti-NMDA receptor encephalitis, which usually affects women.
[snip]
Daniel, a joiner, said he felt unwell with a sore throat before travelling to Rethymnon in Crete but his GP told him he was fit to fly out last December.

?On the second day I had to go to the local doctors in the resort, where they gave me antibiotics and told me to come back on the Tuesday,? he said.

But soon afterwards Daniel collapsed and was rushed to the nearest hospital...

http://archneur.jamanetwork.com/arti...icleid=1714848

Original Investigation | July 22, 2013
Frequency and Characteristics of Isolated Psychiatric Episodes in Anti?N-Methyl-d-Aspartate Receptor Encephalitis ONLINE FIRST
Matthew S. Kayser, MD, PhD1; Maarten J. Titulaer, MD, PhD2,3,4; N?ria Gresa-Arribas, PhD3; Josep Dalmau, MD, PhD2,3,5
[+] Author Affiliations
JAMA Neurol. 2013;():-. doi:10.1001/jamaneurol.2013.3216.
Text Size: A A A
Published online July 22, 2013

News release:
xhttp://www.uphs.upenn.edu/news/News_Releases/2013/07/dalmau/

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

Here's an excellent presentation by a nursing student who had ANMDARE and went back to school only 3 months after treatment and is doing very well!

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Published on Feb 28, 2013

A symposium speech by Chelsea Chisholm. This is regarding my diagnosis of Anti-NMDA Receptor Encephalitis. It is considered a very rare type of autoimmune encephalitis, however, many of the victims believe that it may not be rare, but too often misdiagnosed as psychosis of an unknown cause. Health care members need to be more aware of this condition, as a misdiagnosis can be fatal to the patient.

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://www.annalsofian.org/article.a...71;aulast=Suri

Table of Contents
CASE REPORT

Year : 2013 | Volume : 16 | Issue : 2 | Page : 169-171


Young girl with abnormal behavior: Anti-N-Methyl-D-Aspartate receptor immune encephalitis

Vinit Suri, Sushma Sharma, Rohan Gupta, Nilesh Jadhao, Kunal Suri
Department of Neurology, Indraprastha Apollo Hospitals, New Delhi, India

Date of Submission 01-Jan-2013
Date of Decision 20-Jan-2013
Date of Acceptance 21-Jan-2013
Date of Web Publication 24-May-2013

Correspondence Address:
Sushma Sharma
Department of Neurology, Indraprastha Apollo Hospital, New Delhi
India
DOI: 10.4103/0972-2327.112456

Get Permissions



Abstract

Anti N Methyl D Aspartate receptor immune encephalitis (Anti NMDARE) is a recently defined, under-recognized and often misdiagnosed disease, which typically occurs in young females and may be associated with an underlying tumor, usually ovarian teratoma. If diagnosed early, initiation of immunotherapy and tumor removal (if present) may result in recovery. We report a case of a 17 years old girl with Anti NMDARE who was initially misdiagnosed as Functional psychosis, Neuroleptic Malignant Syndrome and Sepsis syndrome. To the best of our knowledge, this is only the second case of anti NMDARE being reported from India. This case report underscores the need for a greater awareness of this entity across multiple specialties, e.g., general medicine, psychiatry and neurology, to ensure a heightened diagnostic suspicion, which can lead to timely diagnosis and adequate therapy of this treatable disease.

Suri V, Sharma S, Gupta R, Jadhao N, Suri K. Young girl with abnormal behavior: Anti-N-Methyl-D-Aspartate receptor immune encephalitis. Ann Indian Acad Neurol [serial online] 2013 [cited 2013 Aug 26];16:169-71. Available from: http://www.annalsofian.org/text.asp?...6/2/169/112456

Full text at link. The first symptom in this case was abrupt transitioning of a gregarious personality into a very passive, obedient personality.


Another case in the news in Canada involving a younger patient:

http://www.mississauga.com/community...-kids-no-more/

Aug 03, 2013 |
Vote 0 0
BFFs are 'Sick Kids' no more

Staff photo by Rob Beintema
Jayden Liuzza (left) and Fiona Morris are friends with a lot in common. They go to the same school and share similar past experiences - intense treatment at the Hospital for Sick Children for serious conditions.
Mississauga News
...
Fiona went a different route to Sick Kids. She was healthy until she was 3-years-old. Her parents noticed her leg was moving awkwardly when they picked her up from daycare one day.

Within five weeks Jayden was reduced to lying in bed unable to eat, speak or walk. Her body twitched with seizures and even at Sick Kids they couldn't figure out what infection was causing her to deteriorate.

When her rheumatologist sent a specimen of Jayden's spinal fluid to a Pennsylvania researcher they got a diagnosis: Jayden had an auto-immune disease called anti-NMDAR encephalitis that had only been identified in 2007.

Probably triggered by a mild virus like a cold, her body's antibodies were attacking her brain...
ByJan Dean

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://www.thepoisonreview.com/2013/...-encephalitis/

Must-read: Anti-NMDA Receptor Encephalitis
August 28, 2013, 1:35 pm

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis: an etiology worth considering in the differential of delirium. Punja M et al. Clin Toxicol 2013 Aug 20 [Epub ahead of print]

Abstract

This important paper is a must-read, especially for toxicologists who have not heard of this under-appreciated neurological disorder. (I was not aware of it until several days ago, when I found out that a friend of a relative had received the diagnosis.)...

[Emily]

Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://www.tri-cityherald.com/2013/0...ring-from.html

W. Richland woman recovering from rare brain disease; fundraiser set Wednesday

Published: September 15, 2013

A young West Richland woman who hopes to become a nurse someday now faces a long recovery after a brain disease.

Keonie Torres, 21, was diagnosed this summer with a rare form of encephalitis -- anti-NMDA receptor encephalitis -- an auto-immune reaction that occurs when antibodies turn on the brain and cause it to swell.

Read more here: http://www.tri-cityherald.com/2013/0...#storylink=cpy

If her parents had not persisted in getting a second opinion, Ms. Torres was going to be sent to a psych ward. The parents tried to get her into UW and Swedish hospitals in Seattle, but there was no room, so they took her down to Oregon Health and Science University in Portland where she was finally diagnosed. (2 other girls had been recently treated there.)

I'm afraid the medical community in WA state might be behind the curve on recognizing this illness.