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Publication Detail
Anti-N-methyl-D-aspartate receptor antibodies: a potentially treatable cause of encephalitis in the intensive care unit.
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Case Reports
  • Authors:
    Davies G, Irani SR, Coltart C, Ingle G, Amin Y, Taylor C, Radcliffe J, Hirsch NP, Howard RS, Vincent A, Kullmann DM
  • Publication date:
    02/2010
  • Pagination:
    679, 682
  • Journal:
    Crit Care Med
  • Volume:
    38
  • Issue:
    2
  • Status:
    Published
  • Country:
    United States
  • Language:
    eng
  • Keywords:
    Adult, Autoantibodies, Dyskinesias, Encephalitis, Female, Humans, Immunomodulation, Intensive Care Units, Male, Psychotic Disorders, Receptors, N-Methyl-D-Aspartate, Seizures, Stereotypic Movement Disorder
Abstract
OBJECTIVE: To report the occurrence of an unusual neurologic disorder requiring admission to the intensive care unit. DESIGN: Analysis of an observational cohort study of 31 patients with encephalitis admitted over a 4-yr period. SETTING: Neurologic intensive care unit in a tertiary referral center. PATIENTS: We identified N-methyl-D-aspartate receptor antibodies in six patients (two male and four female). All seropositive patients presented with a psychiatric prodrome, before developing seizures and obtundation requiring intensive care unit admission. They exhibited limb and truncal stereotypies and orofacial dyskinesias upon weaning sedation. Two patients had ovarian tumors. INTERVENTIONS: Patients were treated with sedation, antiepileptic drugs, and immunotherapy. One patient received a magnesium infusion and ketamine. MEASUREMENTS AND MAIN RESULTS: N-methyl-D-aspartate receptor antibodies were identified in serum samples by an immunofluorescent cell-based assay. Three patients made a good but slow recovery; two were left with severe neurologic deficits; and one died after return to the referring hospital. These patients accounted for approximately 20% of all patients admitted with encephalitis to this referral center. CONCLUSIONS: N-methyl-D-aspartate receptor antibodies should be tested in patients with hyperkinetic encephalitis and neuropsychiatric prodrome admitted to the intensive care unit. The disorder is probably not rare and is potentially treatable.
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