Anti-NMDAR Encephalitis Appearing as a New-onset Psychosis: Disease Course in Children and Adolescents within the California Encephalitis Project

Publication date: Available online 4 February 2017
Source:Pediatric Neurology
Author(s): Mary Gable, Carol Glaser
BackgroundGiven that psychiatric symptoms are common, not only during the course of the illness, but on presentation, in children and adolescents who suffer from anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, it is important that practitioners in the field of child and adolescent psychiatry possess an adequate understanding of the clinical features and potential treatment of this disease. The clinical characteristics of 24 cases that presented to the California Encephalitis Project (CEP) are described herein.MethodsPatients were referred by physicians, and standardized forms were used to gather demographic, clinical, and laboratory data.ResultsTwenty-four patients between the ages of 2 and 18 were identified. Psychosis was a primary presenting symptom in two-thirds of patients, and just over 20% of these were admitted to an inpatient psychiatric facility. Ultimately, all patients developed psychiatric symptoms during the course of the illness. There was a characteristic progression of symptoms that was consistent with that noted in other studies, with prominent psychiatric symptoms initially which then progressed to seizures and autonomic instability in most patients. All of those examined developed movement abnormalities which included primarily orofacial dyskinesias and choreiform movements.ConclusionsAnti-NMDAR encephalitis, unlike other paraneoplastic or autoimmune encephalitides, affects those 18 and under an estimated 40% of the time based on prior studies. Recognizing the signs and symptoms of this condition is essential to making a diagnosis and initiating timely treatment. Those practicing child psychiatry have an important role in this context.



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