N-methyl-D-aspartate receptor antibodies in post-herpes simplex virus encephalitis neurological relapse

Mov Disord. 2014 Jan;29(1):90-6. doi: 10.1002/mds.25626. Epub 2013 Sep 6.


Herpes simplex virus encephalitis (HSVE) is a devastating condition that relapses, often with a chorea in children, despite adequate antiviral treatment. At relapse, evidence of viral replication is frequently absent, suggesting that the relapse may be immune-mediated. Seven children who had a neurological relapse following their initial encephalitis, identified from 20 cases of pediatric HSVE, were studied. Serum and/or cerebrospinal fluid (CSF) were tested for N-methyl-D-aspartate receptor (NMDAR) and other antibodies previously reported in central nervous system autoimmunity. Five of the 7 relapsing children had choreoathetosis; 2 of these were NMDAR antibody-positive, 2 were negative (1 with HSV-positive CSF), and 1 was not available for testing. An additional patient, who relapsed with cognitive regression but with no movement disorder, was also NMDAR antibody-positive. In 2 of the NMDAR antibody-positive patients who were treated at relapse and in 1 who was treated only after 10 years of having a relapsing encephalopathy, a beneficial response was observed. Neurological relapses after HSVE may frequently be immune-mediated, particularly in children with chorea. NMDAR antibodies are common, and immunotherapy may be beneficial.

Keywords: N-methyl-D-aspartate (NMDA) receptor; choreoathetosis; encephalitis; herpes simplex virus; movement disorder; relapsing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / blood
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / immunology*
  • Autoantibodies / blood*
  • Child, Preschool
  • Encephalitis, Herpes Simplex / blood
  • Encephalitis, Herpes Simplex / immunology*
  • Female
  • Humans
  • Infant
  • Male
  • Receptors, N-Methyl-D-Aspartate / immunology*
  • Recurrence


  • Autoantibodies
  • Receptors, N-Methyl-D-Aspartate