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Bayliss L, Sandoval AM, Nava A, Diaz-Victoria AR, Espinola-Nadurille M, Ramírez-Bermúdez J, Galvez V. Cognitive follow-up in anti-N-methyl-D-aspartate receptor encephalitis: Hospital discharge, 4, 8, and 12 months. Clin Neurol Neurosurg 2023; 228:107701. [PMID: 36996670 DOI: 10.1016/j.clineuro.2023.107701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023]
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Tarantino S, Averna R, Ruscitto C, Ursitti F, Ferilli MAN, Moavero R, Papetti L, Proietti Checchi M, Sforza G, Balestri M, Grimaldi Capitello T, Vigevano F, Vicari S, Valeriani M. Neuropsychological Sequelae, Quality of Life and Adaptive Behavior in Children and Adolescents with Anti-NMDAR Encephalitis: A Narrative Review. Brain Sci 2021; 11:brainsci11111387. [PMID: 34827386 PMCID: PMC8615663 DOI: 10.3390/brainsci11111387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a rare autoimmune illness characterized by a constellation of often severe, but treatable, psychiatric and neurological symptoms. Whereas symptoms such as psychosis and bizarre and abnormal motor behavior are common in adults, pediatric patients typically present with behavioral changes, irritability and sleep dysfunction. The recovery phase is usually slow and may be associated with longstanding adaptive, behavioral and neuropsychological problems. Very few studies explored the cognitive and adaptive sequelae in children with anti-NMDAR encephalitis. The present review article suggests that, although most children and adolescents return to their daily life and previous activities, they may have a low quality of life and show neuropsychological sequelae involving language, memory, especially verbal memory, and attentional resources, even after several months from the hospital discharge. In particular, the available results reveal difficulties in cognitive skills involving executive functions. This impairment is considered the “core” of the cognitive profile of young patients with anti-NMDAR encephalitis. On the other hand, some cognitive skills, such as general intelligence, show good overall recovery over time. Additional neuropsychological research evaluating larger samples, more homogenous methods and longitudinal studies is required.
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Affiliation(s)
- Samuela Tarantino
- Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.C.); (T.G.C.)
- Correspondence:
| | - Roberto Averna
- Child and Adolescence Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (R.A.); (S.V.)
| | - Claudia Ruscitto
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, 00133 Rome, Italy; (C.R.); (R.M.)
| | - Fabiana Ursitti
- Department of Neurology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.U.); (M.A.N.F.); (L.P.); (G.S.); (M.B.); (F.V.); (M.V.)
| | - Michela Ada Noris Ferilli
- Department of Neurology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.U.); (M.A.N.F.); (L.P.); (G.S.); (M.B.); (F.V.); (M.V.)
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, 00133 Rome, Italy; (C.R.); (R.M.)
- Department of Neurology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.U.); (M.A.N.F.); (L.P.); (G.S.); (M.B.); (F.V.); (M.V.)
| | - Laura Papetti
- Department of Neurology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.U.); (M.A.N.F.); (L.P.); (G.S.); (M.B.); (F.V.); (M.V.)
| | - Martina Proietti Checchi
- Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.C.); (T.G.C.)
| | - Giorgia Sforza
- Department of Neurology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.U.); (M.A.N.F.); (L.P.); (G.S.); (M.B.); (F.V.); (M.V.)
| | - Martina Balestri
- Department of Neurology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.U.); (M.A.N.F.); (L.P.); (G.S.); (M.B.); (F.V.); (M.V.)
| | - Teresa Grimaldi Capitello
- Unit of Clinical Psychology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.C.); (T.G.C.)
| | - Federico Vigevano
- Department of Neurology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.U.); (M.A.N.F.); (L.P.); (G.S.); (M.B.); (F.V.); (M.V.)
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (R.A.); (S.V.)
| | - Massimiliano Valeriani
- Department of Neurology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.U.); (M.A.N.F.); (L.P.); (G.S.); (M.B.); (F.V.); (M.V.)
- Center for Sensory-Motor Interaction, Denmark Neurology Unit, Aalborg University, 9100 Aalborg, Denmark
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Nicolle DCM, Moses JL. A Systematic Review of the Neuropsychological Sequelae of People Diagnosed with Anti N-Methyl-D-Aspartate Receptor Encephalitis in the Acute and Chronic Phases. Arch Clin Neuropsychol 2018; 33:964-983. [DOI: 10.1093/arclin/acy005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Della C M Nicolle
- Cardiff University, Tower Building, 70 Park Place, Cardiff CF10 3AT, UK
| | - Jennifer L Moses
- Cardiff University, Tower Building, 70 Park Place, Cardiff CF10 3AT, UK
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Mutti C, Barocco F, Zinno L, Negrotti A, Spallazzi M, Pavesi G, Gardini S, Caffarra P. A case of reversible anti-NMDA-receptor encephalitis: neuropsychological and neuroradiological features. Neurol Sci 2017; 38:2231-2236. [PMID: 28905135 DOI: 10.1007/s10072-017-3105-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/30/2017] [Indexed: 01/17/2023]
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune encephalitis mainly affecting young women. We report a case of a mild paraneoplastic anti-NMDAR encephalitis in a 31-year-old female with an ovarian immature teratoma. The patient exhibited a severe short-term episodic memory impairment and psychiatric symptoms. A detailed diagnostic work-up including complete clinical and laboratory examinations, neuropsychological assessments, and neuroradiological investigations has been done at the onset and during follow-up. The amnestic syndrome and MRI medial-temporal abnormalities reversed after medical and surgical treatment. The present report indicates that the disease can be rapidly reversible if promptly diagnosed and treated. While the disease has already been described elsewhere, the course of neurospychological deficits in adults is not as much known. Usually, when the diagnosis of anti-NMDAR encephalitis is made, the severity of the disease makes the assessment of the neuropsycological profile particulary challenging. The present report is of interest because it describes the complete neuropsychological profile of a mild form of anti-NMDAR encephalitis.
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Affiliation(s)
- Carlotta Mutti
- Department of Medicine and Surgery, Section of Neurology, University of Parma, Via Gramsci 14, 43126, Parma (PR), Italy
| | | | - Lucia Zinno
- Department of Emergency care, General and Specialist Medical Area, AOU, Parma, Italy
| | - Anna Negrotti
- Department of Emergency care, General and Specialist Medical Area, AOU, Parma, Italy
| | | | - Giovanni Pavesi
- Department of Medicine and Surgery, Section of Neurology, University of Parma, Via Gramsci 14, 43126, Parma (PR), Italy
| | | | - Paolo Caffarra
- Department of Medicine and Surgery, Section of Neurology, University of Parma, Via Gramsci 14, 43126, Parma (PR), Italy.
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McKeon GL, Robinson GA, Ryan AE, Blum S, Gillis D, Finke C, Scott JG. Cognitive outcomes following anti-N-methyl-D-aspartate receptor encephalitis: A systematic review. J Clin Exp Neuropsychol 2017; 40:234-252. [DOI: 10.1080/13803395.2017.1329408] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Gemma L. McKeon
- The University of Queensland Centre for Clinical Research (UQCCR), Royal Brisbane and Women’s Hospital (RBWH), Brisbane, QLD, Australia
- Child and Youth Mental Health Group, Queensland Centre for Mental Health Research (QCMHR), The Park–Centre for Mental Health, Brisbane, QLD, Australia
- School of Psychology, The University of Queensland (UQ), Brisbane, QLD, Australia
| | - Gail A. Robinson
- The University of Queensland Centre for Clinical Research (UQCCR), Royal Brisbane and Women’s Hospital (RBWH), Brisbane, QLD, Australia
- School of Psychology, The University of Queensland (UQ), Brisbane, QLD, Australia
| | - Alexander E. Ryan
- The University of Queensland Centre for Clinical Research (UQCCR), Royal Brisbane and Women’s Hospital (RBWH), Brisbane, QLD, Australia
- Child and Youth Mental Health Group, Queensland Centre for Mental Health Research (QCMHR), The Park–Centre for Mental Health, Brisbane, QLD, Australia
| | - Stefan Blum
- The University of Queensland Centre for Clinical Research (UQCCR), Royal Brisbane and Women’s Hospital (RBWH), Brisbane, QLD, Australia
- Neurosciences Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - David Gillis
- Royal Brisbane and Women’s Hospital (RBWH), Brisbane, QLD, Australia
- Pathology Queensland, Herston, QLD, Australia
| | - Carsten Finke
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - James G. Scott
- The University of Queensland Centre for Clinical Research (UQCCR), Royal Brisbane and Women’s Hospital (RBWH), Brisbane, QLD, Australia
- Child and Youth Mental Health Group, Queensland Centre for Mental Health Research (QCMHR), The Park–Centre for Mental Health, Brisbane, QLD, Australia
- Metro North Mental Health, Royal Brisbane and Women’s Hospital (RBWH), Brisbane, QLD, Australia
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McIvor K, Moore P. Spontaneous recovery of memory functions in an untreated case of anti NMDAR encephalitis - a reason to maintain hope. Clin Neuropsychol 2016; 31:289-300. [PMID: 27762163 DOI: 10.1080/13854046.2016.1245358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Anti N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder that was only fully discovered recently and neuropsychological outcome data remains sparse. We present the case of BA, a 19-year-old male, which illustrates the cognitive outcome in an untreated case over a time period of over 2½ years. METHOD We conducted three cognitive assessments, including tests of memory and executive functioning, over this time period and considered the evidence for reliable change in memory function using the Wechsler Advanced Clinical Solutions (ACS) serial assessment package. RESULTS Our findings revealed mild memory problems 6 months post-discharge with, at best, static and potentially declining memory functioning at follow-up assessment 12 months post-discharge. However, the results of testing at 30 months post-discharge revealed significant improvements in immediate and delayed memory index performances. CONCLUSIONS Our report of a case of anti-NMDAR encephalitis provides evidence for spontaneous improvements in memory functioning occurring more than 2 years after initial assessment and also demonstrates both the utility and potential limitations of the ACS serial assessment software when used in a relatively typical clinical assessment situation.
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Affiliation(s)
- Katherine McIvor
- a Department of Clinical Neuropsychology , The Walton Centre NHS Foundation Trust , Liverpool , UK
| | - Perry Moore
- a Department of Clinical Neuropsychology , The Walton Centre NHS Foundation Trust , Liverpool , UK.,b School of Medicine , University of Liverpool , Liverpool , UK
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Hinkle CD, Porter JN, Waldron EJ, Klein H, Tranel D, Heffelfinger A. Neuropsychological characterization of three adolescent females with anti-NMDA receptor encephalitis in the acute, post-acute, and chronic phases: an inter-institutional case series. Clin Neuropsychol 2016; 31:268-288. [DOI: 10.1080/13854046.2016.1191676] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Clayton D. Hinkle
- Department of Psychiatry, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Division of Neuropsychology, Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James N. Porter
- Midwestern Neuropsychology PLLC, Edina, MN, USA
- Division of Neuropsychology, Department of Psychology, University of Iowa, Iowa City, IA, USA
| | - Eric J. Waldron
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, USA
| | - Hannah Klein
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Daniel Tranel
- Division of Neuropsychology, Department of Psychology, University of Iowa, Iowa City, IA, USA
- Department of Psychology, University of Iowa, Iowa City, IA, USA
| | - Amy Heffelfinger
- Division of Neuropsychology, Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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