Anti-NMDA-Receptor Encephalitis of Thai Patients:
Description of a Consecutive Series of Patients over
10 Years and a Literature Review
Sapol Thepwiwatjit1, Jiraporn Jitprapaikulsan MD2
Affiliation :
1 Medical Student; Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2 Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Anti-N-methyl-D-aspartate receptor [anti-NMDAR] encephalitis is an autoimmune encephalitis commonly associated
with ovarian teratoma [OT]. Currently, there is no literature for anti-NMDAR encephalitis in Thai patients who may have different
clinical manifestations compared to patients from other regions.
Objective : To evaluate the clinical characteristics, assessments, and outcomes of a series of anti-NMDAR encephalitis in Thai patients
and review of the literature.
Materials and Methods : All adult Thai patients with anti-NMDAR encephalitis con(cid:976)irmed positive by one anti-NMDAR antibody
test, either in serum or cerebrospinal (cid:976)luid [CSF], and hospitalized in the Department of Medicine, Siriraj Hospital, Thailand, between
2007 and 2016, were identi(cid:976)ied from the hospital’s database.
Results : Nine patients with a median age of 21 years (range 15 to 49), including eight (89%) that were female, were included in
this study. Initial presentations included seizures (4 patients, 44%), psychiatric symptoms (4, 44%), and cognitive impairment
(1, 11%). Chronic relapsing in(cid:976)lammatory optic neuropathy proceeded to encephalopathy in one patient (11%). Six patients (67%)
had abnormalities in brain imaging, revealed by computed tomography with contrast or magnetic resonance imaging, or both.
Leptomeningeal enhancement was present in two patients (22%). An OT was found in three out of six patients (50%), all of whom
underwent tumor removal. Immunotherapy was given to all patients. Clinical outcomes were marked recovery in four patients
(44%), persistent cognitive de(cid:976)icit and partial dependency in two (22%), and death by hospital-acquired pneumonia in two (22%).
Conclusion : The majorities of the initial manifestations of anti-NMDAR encephalitis in the Thai patients were seizures and psychiatric
symptoms. The (cid:976)irst episode of seizure without other neurological abnormalities especially among young adult women may reveal
anti-NMDAR encephalitis. CRION may precede such an encephalitis. Leptomeningeal enhancement, with or without intraparenchymal
lesion, may be more frequently seen in Thai patients.
Keywords : Anti-NMDAR encephalitis, Thai, Seizure, Leptomeningeal enhancement, CRION, Recurrent optic neuritis
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