Neuropsychological assessment as an objective tool to monitor treatment response in anti-N-methyl-D-aspartate receptor encephalitis

BMJ Case Rep. 2018 Jun 8;2018:bcr2018224169. doi: 10.1136/bcr-2018-224169.

Abstract

We report a 1-year follow-up of a young woman with anti-N-methyl-D-aspartate receptor encephalitis. Management of autoimmune encephalitis remains challenging as objective and clinically relevant biomarkers are sought, which allow for the monitoring of treatment response. While further investigation is required, we believe that this case highlights the importance of following a comprehensive neuropsychological profile as a clinically relevant biomarker to guide therapeutic decision-making. By relying on the neuropsychological assessment of the patient, treatment with more toxic medications was avoided and her antiepileptic drug regimen was simplified.

Keywords: clinical neurophysiology; epilepsy and seizures; immunology; memory disorders (psychiatry).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / blood
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / cerebrospinal fluid
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / drug therapy
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / psychology*
  • Anticonvulsants / administration & dosage
  • Anticonvulsants / therapeutic use
  • Antineoplastic Agents, Immunological / therapeutic use
  • Autoimmune Diseases of the Nervous System / blood
  • Autoimmune Diseases of the Nervous System / cerebrospinal fluid
  • Autoimmune Diseases of the Nervous System / drug therapy
  • Autoimmune Diseases of the Nervous System / psychology*
  • Confusion / diagnosis
  • Confusion / etiology
  • Electroencephalography / methods
  • Epilepsia Partialis Continua / diagnostic imaging
  • Epilepsia Partialis Continua / drug therapy
  • Epilepsia Partialis Continua / physiopathology
  • Female
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use
  • Magnetic Resonance Imaging / methods
  • Monitoring, Physiologic / standards
  • Neuropsychological Tests / standards*
  • Plasma Exchange / methods
  • Rare Diseases
  • Receptors, N-Methyl-D-Aspartate / immunology*
  • Rituximab / administration & dosage
  • Rituximab / therapeutic use
  • Steroids / administration & dosage
  • Steroids / therapeutic use
  • Treatment Outcome

Substances

  • Anticonvulsants
  • Antineoplastic Agents, Immunological
  • Immunosuppressive Agents
  • Receptors, N-Methyl-D-Aspartate
  • Steroids
  • Rituximab