Citation

Yang P, Li L, Xia S, Zhou B, Zhu Y, Zhou G, Tu E, Huang T, Huang H, Li F. Front. Neurosci. 2019; 13(APR).

Copyright

(Copyright © 2019, Frontiers Research Foundation)

DOI

10.3389/fnins.2019.00315

PMID

unavailable

Abstract

The main clinical manifestations of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis are acute or subacute seizures, cognition impairment, and psychiatric symptoms. Nowadays, the scheme of antipsychotic therapy for this disease has not been established. This study reports three cases of anti-NMDAR encephalitis with psychiatric symptoms. The anti-NMDAR antibodies in cerebrospinal fluid (CSF) and serum were positive. The psychiatric symptoms still existed after intravenous immunoglobulin (IVIG) treatment; thus, clozapine was used for antipsychotic therapy. Case 1 was a 37-year-old man who suffered from bad mood and suicide behaviors for 1 month. Hallucination and delusion still existed after IVIG treatment and hormone therapy, and the symptoms were relieved when given clozapine for 12 months. Case 2 was a 28-year-old man who was admitted to our hospital due to injuring other people and destructive behaviors for 2 days. He showed irritability, bad temper, declined cognition, and severe delusion of persecution after IVIG treatment and hormone therapy, but the psychiatric symptoms disappeared when given clozapine for 3 months. Case 3 was a 23-year-old man who suffered from headache and babbing for 7 days. Symptoms such as irritability, bad temper, babbing, and injuring other people still existed after IVIG treatment and hormone therapy, but they disappeared when given clozapine for 2 months. Therefore, we suggest that during the treatment of anti-NMDAR encephalitis with psychiatric symptoms, if the anti-NMDAR antibodies in CSF and serum were positive, and psychiatric symptoms could not be controlled after IVIG and hormone therapy, clozapine may work. © 2019 Yang, Li, Xia, Zhou, Zhu, Zhou, Tu, Huang, Huang and Li.

Language: en

Keywords

adult; human; cognition; suicide; male; case report; depression; aggression; behavior change; heart failure; hospitalization; treatment outcome; clozapine; Clozapine; mood disorder; serum; epilepsy; mental disease; symptomatology; disease association; clinical article; hospital admission; sertraline; hallucination; headache; quetiapine; intensive care unit; nuclear magnetic resonance imaging; diazepam; delusion; seizure; follow up; drug efficacy; olanzapine; irritability; computer assisted tomography; valproic acid; side effect; clonazepam; treatment failure; hormonal therapy; leukocyte count; respiratory failure; midazolam; aciclovir; electroencephalography; brain region; methylprednisolone; antivirus agent; muscle rigidity; disease duration; Psychiatric symptoms; slurred speech; aripiprazole; auditory hallucination; Article; cerebrospinal fluid; treatment duration; Antipsychotic therapy; prednisolone; Positive and Negative Syndrome Scale; visual hallucination; cell count; virus encephalitis; immunoglobulin; slow brain wave; ultrasound; levetiracetam; anti n methyl d aspartate receptor encephalitis; anterior frontotemporal region; Anti-NMDA receptor encephalitis; B ultrasound; babbing; encephalatrophy; Hormone; Intravenous immunoglobulin; n methyl dextro aspartic acid receptor antibody