Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Favorable Outcome Despite Prolonged Status Epilepticus

被引:22
作者
Lenoir, Xavier Finne [1 ]
Sindic, Christian [2 ,3 ]
van Pesch, Vincent [2 ,3 ]
El Sankari, Souraya [2 ]
de Tourtchaninoff, Marianne [2 ]
Denays, Roger [4 ]
Hantson, Philippe [1 ]
机构
[1] Catholic Univ Louvain, Dept Intens Care, B-1200 Brussels, Belgium
[2] Catholic Univ Louvain, Dept Neurol, B-1200 Brussels, Belgium
[3] Catholic Univ Louvain, Neurochem Lab, B-1200 Brussels, Belgium
[4] Ctr Hosp Reg Namur, Dept Neurol, Namur, Belgium
关键词
Encephalitis; Anti-NMDA receptor antibodies; Status epilepticus; Seizure management; Ketamine; Immunosuppressive therapy; NMDAR ENCEPHALITIS; ANTIBODIES;
D O I
10.1007/s12028-012-9788-8
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
To describe a case of auto-immune encephalitis in an adolescent with favorable outcome despite prolonged status epilepticus. A 17 year old Asian man without previous medical history developed alteration of consciousness and partial seizures. The diagnosis of anti-N-methyl-D-aspartate receptor encephalitis was confirmed by the detection of specific antibodies in both cerebrospinal fluid and serum. The clinical course was complicated by prolonged status epilepticus which was refractory to a large number of antiepileptic drugs, including barbiturate coma. Immunomodulatory therapy included steroids, plasma exchanges, and intravenous immunoglobulins. After 86 days of intensive therapy, the patient regained consciousness progressively. Brain magnetic resonance imaging never demonstrated any lesion. Extensive search for a tumor was negative. At 12 month follow-up, the patient had made an excellent recovery. Auto-immune encephalitis is likely underdiagnosed in adolescents. In their most severe presentation, seizures may be resistant to a large number of anti-epileptic drugs, and the clinical improvement seems to be mainly because of the immunomodulatory therapy. Relapse is possible, as well as the delayed development of a teratoma or other tumor.
引用
收藏
页码:89 / 92
页数:4
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