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Abdel Aziz K, Stip E, Arnone D. More than just anti-NMDAR: the many facets of autoimmune encephalitis. BJPsych Bull 2021; 46:1-5. [PMID: 34842123 PMCID: PMC9768525 DOI: 10.1192/bjb.2021.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/03/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022] Open
Abstract
This editorial expands on a Praxis article published by Beattie and colleagues in the trainees' section of this journal. The authors describe an interesting case of anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis, outline the clinical presentation and make suggestions on ways to approach this rare disorder. Here we provide an overview of autoimmune conditions that result in the production of autoantibodies targeting central nervous system proteins mediating autoimmune encephalitis and offer a perspective on approaches to diagnosis and treatment.
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Affiliation(s)
- Karim Abdel Aziz
- College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Emmanuel Stip
- College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
- Institute Universitaire en Santé Mentale de Montréal, Université de Montréal, Canada
| | - Danilo Arnone
- College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Dinoto A, Cheli M, Bratina A, Sartori A, Manganotti P. Bortezomib in anti-N-Methyl-d-Aspartate-Receptor (NMDA-R) encephalitis: A systematic review. J Neuroimmunol 2021; 356:577586. [PMID: 33975246 DOI: 10.1016/j.jneuroim.2021.577586] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 01/05/2023]
Abstract
N-methyl-d-aspartate receptor (NMDAR) encephalitis is a potentially treatable condition, although a small proportion of patients remains refractory to immunotherapy. Bortezomib is a proteasome inhibitor that has a promising role in autoimmune conditions. We performed an independent PubMed search employing "Anti-N-Methyl‑D-Aspartate encephalitis AND bortezomib", including papers published between January 1st, 2007 to April 15th, 2021. Fourteen articles were included, with 29 patients. 16 patients (55,2%) had a favorable outcome after bortezomib and 11 (37,9%) patients developed side effects. Quality of studies was overall poor and future trials should aim to include more homogeneous and larger cohorts.
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Affiliation(s)
- Alessandro Dinoto
- Neurology Unit, "San Martino" Hospital, AULSS 1 - Dolomiti, Viale Europa, 22, 32100 Belluno, Italy; Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
| | - Marta Cheli
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Alessio Bratina
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
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Refractory NMDA-receptor encephalitis in a teenager: A novel use of Bortezomib. J Neuroimmunol 2021; 355:577565. [PMID: 33813318 DOI: 10.1016/j.jneuroim.2021.577565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 02/02/2023]
Abstract
We report the case of a 14-year-old girl who was diagnosed with N-methyl-d-aspartate (NMDA)-receptor encephalitis, with severe features and autonomic instability, requiring intensive care unit admission. She had poor clinical response to the first-line therapies, she was then started on Rituximab and 6 cycles of Cytoxan infusion. She responded to Bortezomib therapy within 2 weeks of initiation, and with long-term sustenance of improvement in the long-term, also demonstrated by an improvement in NMDA titers . As far as we know, this is the first report of use of Bortezomib therapy in a child with refractory NMDA-receptor encephalitis.
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