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Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

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

http://www.mercurynews.com/health/ci_25600426/misdiagnosed-bipolar-one-girls-struggle-through-psych-wards?source=pkg
Misdiagnosed bipolar: One girl's struggle through psych wards before Stanford doctors make bold diagnosis and treatment
Julia Prodis Sulek
Posted: 04/19/2014 04:16:41 PM PDT57 Comments | Updated: 5 days ago

...

Controversial diagnosis

What Frankovich, a pediatric rheumatologist, and Dr. Kiki Chang, a child psychiatrist, concluded was that Tessa likely had an infection or other trigger that caused her immune system to mistakenly attack her brain, dramatically changing Tessa's behavior overnight. It's a condition called PANS -- pediatric acute-onset neuropsychiatric syndrome -- that in some cases, if caught early enough, could be cured by commonly used antibiotics. Without early treatment, they say, children can suffer needlessly.
...
"To know how many patients are in mental institutions that have treatable diseases," Frankovich said, "we can't even wrap our head around this."...
 
Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

Detailed report of a battle with anti-NMDAR encephalitis:

http://www.washingtonpost.com/national/health-science/the-doctor-and-the-teenager/2014/04/28/e92eadaa-98b2-11e3-b931-0204122c514b_story.html
The doctor and the teenager

By Sandra G. Boodman, Published: April 28

As the jet hurtled toward New York?s John F. Kennedy International Airport on New Year?s Day 2013, the clinical psychologist watched her 16-year-old daughter warily, praying there would be no recurrence of the girl?s inexplicable and bizarre behavior.

...

Carmen remembers feeling elated by this turn of events. ?You think, ?Well, that?s it, they know what it is and they?re going to cure her and she?s going to be out of here in three days,? she said.

But Marcuse knew that nothing could be further from the truth. Mia?s illness is ?like walking someone through Hades,? the neurologist said. ?And most people get worse before they get better.?...
 
Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://news.pennmedicine.org/blog/2014/01/obscure-neurologic-diseases-discovered-at-penn-to-be-focus-of-new-center.html
Obscure Neurologic Diseases Discovered at Penn to be Focus of New Center
Posted by Kim Menard on January 29, 2014
...
The new center, developed through Penn?s department of Neurology, will be run by leaders in the field including center director Josep Dalmau, MD, PhD, adjunct professor of Neurology and Eric Lancaster, MD, PhD, assistant professor of Neurology. The clinic will focus on consultations and long-term care of patients with antibody mediated neurological diseases such as anti-NMDA receptor encephalitis. Physicians from outside hospitals can refer patients to the center, and patients with a positive antibody diagnosis can make appointments for follow-up care. Additionally, Penn neurologists will handle in-patient consults of those hospitalized at the Hospital of the University of Pennsylvania with autoantibody disorders...

Pediatric Neurology
Available online 29 May 2014
Three phenotypes of anti-NMDA receptor antibody encephalitis in children: prevalence of symptoms and prognosis

Allen D. DeSena, MD, MPHa, b, Benjamin M. Greenberg, MD, MHSa, b,
Donna Graves, MDa, b

...

Results

We note that the poorest responders, even to aggressive immunotherapies, are the catatonia persistent type anti-NMDA receptor antibody encephalitis, which has as its hallmark, prolonged periods of severe encephalopathy. Patients with predominantly psychiatric symptoms, which we call the psychiatric predominant NMDA receptor antibody encephalitis, have had excellent responses to plasma exchange or other immunotherapies and appear to have the least residual deficits at follow-up. Patients with fairly equal representations of periods of altered mental status, behavior problems, and movement disorders appear to have an intermediate prognosis and likely require early aggressive immunotherapy...
 
Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://www.tennessean.com/story/news/local/2014/06/02/donations-help-girl-encephalitis-fight/9860755/
Donations help girl, 6, in encephalitis fight
Maranda Faris; 7:26 a.m. CDT June 2, 2014
The mother of a 6-year-old South Nashville girl has taken to the Internet to raise money for the medical bills her daughter has accumulated after she developed a disease that began to attack her brain.

On April 17, Callie Hulsey had a seizure at school.
...
A week before her hospitalization, Callie had an ear infection. That, doctors told her mother, caused viral meningitis. The bout of meningitis, in turn, caused encephalitis to attack Callie?s brain, the doctors said.

Last week, Callie?s doctors told the Hulsey family that their daughter has anti-NMDA receptor antibody encephalitis, an autoimmune form of encephalitis that causes inflammation in the brain...
 
Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://philadelphia.cbslocal.com/2014/06/10/health-mysterious-brain-illness-causes-terrifying-outbursts/
Health: Mysterious Brain Illness Causes Terrifying Outbursts
June 10, 2014 1:27 PM

PHILADELPHIA (CBS) ? It?s a mysterious brain illness that triggers psychotic and violent behavior.

It is rare, and it is often misdiagnosed.

One desperate family grabbed a video camera to document what was happening.

...

A blood test finally revealed PANS ? Pediatric Acute-onset Neuropsychiatric Syndrome. It?s marked by sudden and dramatic outbursts and obsessive behavior, and it?s unusual.

We discovered that he actually had an autoimmune disease attacking his blood and blood vessels,? explains Dr. Jennifer Frankovitch.

It was also attacking the brain, triggering psychiatric problems.

A lot isn?t known about the newly identified syndrome.

?Maybe about 14 to 40 percent of the cases, we think strep triggers it?we just don?t know yet,? Dr. Frankovitch says...

The symptoms started in 2009 at age 7.
 
Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://www.foxsports.com/southwest/story/cowboys-okoye-making-comeback-after-missing-13-season-with-rare-disease-082214
Cowboys' Okoye making comeback after missing '13 season with rare disease
Shawn Ramsey
FOX Sports Southwest
AUG 22, 2014 12:37p ET
In 2013, defensive tackle Amobi Okoye was diagnosed with a rare autoimmune syndrome called anti-NMDA receptor encephalitis. Now he is working hard to make a comeback to the NFL with the Dallas Cowboy...


http://espn.go.com/blog/afceast/post/_/id/71423/amobi-okoye-an-inspiration-to-teammates
Amobi Okoye an inspiration to teammates
August, 21, 2014
By Todd Archer | ESPN.com

...

Okoye spent roughly three months in a coma as a result of anti-NMDA receptor encephalitis, a potentially fatal brain disease. He had to learn how to communicate all over again. A high school graduate at 16, who his agent, Ian Greengross, said could have gone to Harvard, Okoye had trouble with the simplest tasks....

http://theday.com/article/20140823/SPORT02/308239971/-1/SPORT
Strong in spirit, Coast Guard's Kelsey Hickle rises to defeat adversity
By Vickie Fulkerson Publication: The Day
Published August 23. 2014 4:00AM

New London ? On one of her worst days, Kelsey Hickle didn't recognize her father, Bill, when he flew from Texas to see her at Yale-New Haven Hospital.

She couldn't speak, couldn't feed herself, couldn't shower, couldn't write.

Hickle, who wore a blue star on her uniform at the Coast Guard Academy for the highest achievement in physical fitness and who at the time was a sophomore member of the volleyball team, had been stricken by a rare disease, Anti-NMDA receptor encephalitis.

The symptoms started slowly. She was tired no matter how much sleep she got. She couldn't concentrate. Her emotions were a roller coaster. Bible verses which she long ago memorized didn't make sense to her. Nothing made sense. Eventually, she was rendered catatonic...
 
Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://link.springer.com/article/10.1007%2Fs13760-013-0204-8
Get Access
Find out how to access preview-only content
Acta Neurologica Belgica
September 2014, Volume 114, Issue 3, pp 233-234
Date: 14 May 2013
Remarkable effect of benzodiazepine in a patient with anti-NMDA receptor encephalitis

?ağdaş Erdoğan, İsmail Sarı, Hasan Herken, Eylem Değirmenci, Attila Oğuzhanoğlu

This is an excerpt from the content

Here, we report a case of anti-NMDA receptor encephalitis with a history of vaccination in which peroral low dosages of benzodiazepines caused reversible episodes of wakefulness.

A 42-year-old male patient presented with a reversible attack of blurred vision, paresthesia in his right hand followed by psychiatric symptoms, visual hallucinations, and episodes of disorientation. In the end of the first month, he experienced seizures. He had a history of vaccination just 3 weeks before the symptoms started. Cranial imaging was within normal limits. EEG demonstrated persistent, repeated sharp waves localized to left parietal cortex. Cerebrospinal fluid (CSF) examination revealed an elevated protein level without any cells or microorganism. All infectious markers were negative. Antinuclear antibody profile, lupus anticoagulants were also negative. Whole body 18F-fluorodeoxyglycose positron emission tomograpghy (FDG-PET) demonstrated hyperactivity in bilateral temporoparietal cortex...
 
Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://www.rhyljournal.co.uk/news/139439/st-asaph-woman-speaks-out-about-rare-breaking-bad-type-illness.aspx
St Asaph woman speaks out about rare "Breaking Bad" type illness

Published date: 15 October 2014 |
Published by: Dean Jones
Ceri Parry, aged 25, suffers from a rare type of Autoimmune Limbic Encephalitis called Anti-NMDA Receptor, an illness where the body?s immune system attacks part of the brain responsible for mood, memory and learning.

After being misdiagnosed several times, Miss Parry is now receiving treatment and is seeking funding to aid her recovery following a positive blood test in August.
...
Miss Parry, who believe the condition originated when she was working in America aged 19, expressed that she wanted to share her story to ?stop others going through what she has experienced.?

?I went to work at a camp in America for three months and was bitten by something whilst on a road trip,? she added...

The article says this young woman is having a hard time getting medical treatment due to being from Wales. :(
 
Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://link.springer.com/article/10.1007/s10072-014-1708-6
Neurological Sciences
July 2014, Volume 35, Issue 7, pp 1147-1149
Date: 22 Mar 2014
Reversible symmetrical external capsule hyperintensity as an early finding of autoimmune encephalitis
L Mumoli, A Labate, G Palamara, M Sturniolo? - Neurological Sciences - Springer

A variety of autoimmune etiologies such as anti-LGI1 encephalitis and anti-N-methyl-D-aspartic acid receptor (anti-NMDAR) are being increasingly recognized as causes of encephalitis in children and adolescent [1, 2]. Although many cases of autoimmune ...
 
Re: Anti-NMDA receptor encephalitis and other emerging autoimmune brain diseases

http://www.myfoxaustin.com/story/27565994/boy-with-rare-disease-meets-cowboys-player-with-same-illness
Boy with rare disease meets Cowboys player with same illness
Posted: Saturday, December 6, 2014 9:07 PM EST Updated: Sunday, December 7, 2014 2:02 AM EST
...
The Thompson's said besides giving them hope and their son some encouragement, the Okoye's also shared some information about treatment options with them. They have exchanged phone numbers and plan to keep in touch.

http://www.2minutemedicine.com/cxcl13-shows-potential-anti-nmda-receptor-encephalitis-biomarker/
CXCL13 shows potential as anti-NMDA receptor encephalitis biomarker
December 2, 2014 | Ashley Aaroe and James Jiang
 
The Tohoku Journal of Experimental Medicine [h=1]Vol. 235 (2015) No. 3 March p. 223-231 [/h] [h=2]Expression of N-Methyl-D-Aspartate Receptor Subunits in the Bovine Ovum: Ova as a Potential Source of Autoantigens Causing Anti-NMDAR Encephalitis [/h] Naoko Tachibana[SUP]1)[/SUP], Michiaki Kinoshita[SUP]2)[/SUP], Fuyuki Kametani[SUP]3)[/SUP], Keiko Tanaka[SUP]4) 5)[/SUP], Yumi Une[SUP]6)[/SUP], Yotaro Komatsu[SUP]7)[/SUP], Yukihiro Kobayashi[SUP]8)[/SUP], Shu-ichi Ikeda[SUP]2)[/SUP] [h=1]Abstract[/h] Autoimmune synaptic encephalitis is characterized by the presence of autoantibodies against synaptic constituent receptors and manifests as neurological and psychiatric disorders. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is such an autoimmune disorder that predominantly affects young women. It is associated with antibodies against the extracellular region of the NR1 subunit of postsynaptic NMDAR. Each NMDAR functions as a heterotetrameric complex that is composed of four subunits, including NR1 and NR2A, NR2B, or NR2C. Importantly, ovarian teratoma is a typical complication of anti-NMDAR encephalitis in female patients and may contain antigenic neural tissue; however, antigenic sites remain unknown in female patients without ovarian teratoma. The purpose of this study was to investigate the expression of NMDARs in the ovum. We detected NR1 and NR2B immunoreactivity in protein fractions extracted from the bovine ovary and ova by SDS-polyacrylamide gel electrophoresis and immunoblotting analysis. Immunoprecipitates digested with trypsin were analyzed by reverse phase liquid chromatography coupled to tandem mass spectrometry. We obtained the following five peptides: SPFGRFK and KNLQDR, which are consistent with partial sequences of human NR1, and GVEDALVSLK, QPTVAGAPK, and NEVMSSK, which correspond to those of NR2A, NR2B and NR2C, respectively. Immunocytochemical analysis revealed that the bovine ovum was stained with the immunoglobulin G purified from the serum of a patient with anti-NMDAR encephalitis. Taken together, we propose that the normal ovum expresses NMDARs that have strong affinity for the disease-specific IgG. The presence of NMDARs in ova may help explain why young females without ovarian teratomas are also affected by anti-NMDAR encephalitis.

Full text at link.
 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614336/
Almuslamani A, Mahmood F. First Bahraini adolescent with anti-NMDAR-Ab encephalitis. Qatar Medical Journal. 2015;2015(1):2. doi:10.5339/qmj.2015.2. [h=2]Abstract[/h] Anti-N-methyl-D-aspartate-receptor (NMDA-R) encephalitis is a new autoimmune, often paraneoplastic disorder that presents with complex neuropsychiatric symptoms. It was first described in 2007 by Dalmau et al. Our patient presented with headache, behavioral changes and then seizures with hallucinations. She was initially misdiagnosed to have schizophrenia and was prescribed antipsychotics. She deteriorated and developed further seizures with hypoventilation and choreoathetosis. Her blood investigations were positive for mycoplasma IGM. Her CSF studies showed high white cell counts, predominantly lymphocytes, and high anti-NMDA-R titre. Her brain MRI scans showed high tbl2 and FLAIR intensities in the grey and white matter of the left cerebellar hemisphere suggestive of acute disseminated encephalomyelitis. She responded to treatment with antibiotics, multiple antiepileptics, steroids and needed five sessions of plasmapheresis. There was no underlying malignancy on repeated scanning of the abdomen. She needed around one year for full recovery with intensive rehabilitation. The objective of this paper was to highlight the occurrence of this fairly new, challenging, easily missed, not-so-rare form of encephalitis often occurring in the absence of fever.

Keywords: anti-N-methyl-D-aspartate receptor antibody (anti-NMDAR-Ab), encephalitis, central nervous system (CNS), acute disseminated encephalomyelitis (ADEM)

Full text at link.
 
Seronegative autoimmune encephalitis - struggle to find diagnosis and treatment:

http://www.indianapolismonthly.com/longform/wonder-years-inside-medical-mystery/
[h=1]The Wonder Years: Inside a Medical Mystery[/h] [h=2]We spent the prime of our daughter?s childhood in doctors? offices and hospital clinics. No one could tell us what was wrong with Rory?a medical mystery that not only took a toll on her health, but on our family as well.[/h] April 26, 2016Alicia Garceau

The Autoimmune Encephalitis Alliance:
https://aealliance.org/
 
http://www.cjdccountry.com/News/Story.aspx?ID=2196891
[h=3]Colban's story - a boy with a rare disease, in a rural area[/h] 6/3/2016

Colban Mcleod was a healthy 5 year old boy.
But last August, everything changed.
...
Sorin says it was hard to watch her grandson suffer, "it was just so overwhelming...his seizures started getting really bad. One morning he had more than 50 seizures in 5 hours - they lost count after 50.?
His MRI came back normal. But a lumbar puncture, otherwise known as a spinal tap, revealed Colban had anti-NMDA receptor encephalitis ? a rare auto-immune disease...

Canada's Anti-NMDA Receptor Encephalitis Foundation, founded by mother whose daughter was the first positively identified case in Canada in 2008:
http://www.antinmdafoundation.org/
 
India: ANDHRA PRADESH

GUNTUR, July 22, 2016
Updated: July 22, 2016 06:05 IST
Girl battles Rasmussen?s encephalitis

STAFF REPORTER

A four-year-old girl diagnosed with a rare autoimmune disorder, Rasmussen?s encephalitis, is being treated by neurologists at the Government General Hospital here.

Rasmussen, 92, a neurosurgeon had done extensive research on the disease, and identified the disease as having a poor prognosis. The symptoms of the disease, also known as chronic focal encephalitis, include seizures and paralysis of left upper and lower limb. The patient will continue to have seizures which is termed as epilepsia partialis continua despite using multiple anti-epileptic drugs.

After conducting a series of clinical tests and collaborating with imaging evidence, Head of Department of Neurology N.V. Sundarachary said that though the exact cause was not known, the disorder could be due to sub-acute chronic infection or autoimmune attack on Glutamate 3 receptors in the brain.
...
http://www.thehindu.com/news/nation...es-rasmussens-encephalitis/article8883672.ece
 
Excellent article by a mother and founder of Canada's Anti-NMDA Receptor Encephalitis Foundation support group.
https://www.madinamerica.com/2016/0...ossession-to-anti-nmda-receptor-encephalitis/
[h=1]Not So Rare But Rarely Diagnosed: From Demonic Possession to Anti-NMDA Receptor Encephalitis[/h]
By
Nesrin Shaheen
August 24, 2016

...
There is growing consensus in the medical community that many prior accounts of ?demonic possession? may have represented original accounts of what is now broadly known as ?autoimmune encephalitis?. This term unifies a broad number of autoimmune diseases, which all result in severe symptomatic brain inflammation owing to an antibody-mediated attack on central nervous system tissues that is sufficient to account for the clinical presentation. Perhaps the best understood medical surrogate for demonic possession is the recently characterized diagnosis of anti-NMDA receptor encephalitis (NMDARE). To the patient or their loved ones, it is a malady like no other, characterized by the rapid onset of symptoms so fierce and so encompassing, that the patient is often described ?as if possessed?.

The first diagnosed case of NMDARE in Canada occurred in a 12-year-old girl seen at the Children?s Hospital of Eastern Ontario (Ottawa, Ontario) in 2008. Symptoms began insidiously with memory loss following a flu-like illness. The child would ask a question of her mother, and then following an explanation, would ask it again. Routine blood tests and neurological testing in the local emergency department were unrevealing; the symptoms were attributed to anxiety and the patient was discharged to the care of her general practitioner...
 
http://link.springer.com/article/10....908-017-0556-y
Galli, J., Clardy, S.L. & Piquet, A.L. Curr Infect Dis Rep (2017) 19: 1. doi:10.1007/s11908-017-0556-y
NMDAR Encephalitis Following Herpes Simplex Virus Encephalitis

Abstract

Purpose of Review

Herpes simplex virus encephalitis (HSVE) is often associated with significant morbidity and mortality, and despite appropriate treatment with antivirals, worsening of neurological symptoms or relapse occurs in a subset of patients. Recent data suggests that many relapses are likely caused by a secondary immune response, with the N-methyl-D-aspartate receptor (NMDAR) antibody being the most commonly associated autoantibody. We provide a review of the relevant literature, examining the relationship between HSVE and development of autoimmunity.

Recent Findings

Autoantibodies, including pathogenic NMDAR antibody, have been demonstrated in the cerebrospinal fluid (CSF) of patients following HSVE. This occurs usually several weeks following initial HSV infection.

Summary

There is growing evidence of a relationship between HSVE and the subsequent development of NMDAR encephalitis. Possible mechanisms include molecular mimicry or an immune response to direct neuronal damage. Future studies should address if the use of immunotherapy can prevent the development of autoimmunity following HSVE.

Keywords

N-methyl-D-aspartate receptor (NMDAR) antibody Herpes simplex virus Encephalitis Autoimmune Cell surface antibody
This article is part of the Topical Collection on Neurological Infections
 
http://www.msard-journal.com/article/S2211-0348(16)30247-4/abstract?cc=y=
[h=4]Antecedent anti-NMDA receptor encephalitis in two patients with multiple sclerosis[/h] Baheerathan, A. et al.
Multiple Sclerosis and Related Disorders , Volume 12 , 20 - 22
[h=2]Highlights[/h]
  • ?Overlap has been shown between anti-NMDAR encephalitis and demyelinating disorders.
  • ?NMDAR antibody testing should be considered in atypical relapses of MS.

[h=2]Abstract[/h] Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder characterised by psychiatric symptoms, movement disorder and seizures often evolving into a severe encephalopathy. An overlap has recently been recognised between anti-NMDAR encephalitis and inflammatory demyelinating disorders, particularly neuromyelitis optical spectrum disorder (NMOSD).
In this case report, we describe two patients with an initial presentation consistent with anti-NMDAR encephalitis who have subsequently developed relapsing-remitting multiple sclerosis (MS) and discuss the literature pertaining to potential overlap between NMDAR encephalitis and inflammatory demyelinating disorders.
 
http://www.hertfordshiremercury.co....ar-stevenage/story-30285668-detail/story.html
[h=1]Family pay tribute to 'beautiful, selfless and loving' woman who died in A1(M) crash near Stevenage[/h] By Matthew_MH | Posted: April 21, 2017
...


Five years ago, the close-knit family endured heartache when Amelia's cousin Yasmin Johnson died at the age of 18.
She had a rare illness called anti NMDA receptor encephalitis, which means antibodies produced by the body's own immune system attack nerve receptors in the brain.
Olivia, who recently moved out of the family home with Nina, said: "I know Amelia never got over that.
"She and Yasmin were so close, like the best of friends. They grew up together, and Yasmin was like another sister to us. It's a comfort to know that they are together again now."..
 
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