ECTRIMS eLearning

Two pediatric cases of Anti-NMDA receptor encephalitis with MS-typical lesions
Author(s): ,
L. Marcus
Affiliations:
UAB | Pediatrics | Child Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
J. Ness
Affiliations:
UAB | Pediatrics | Child Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
ECTRIMS Learn. Marcus L. 10/10/18; 229170; EP1331
Lydia Marcus
Lydia Marcus
Contributions
Abstract

Abstract: EP1331

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Paediatric MS

Objective: To examine two pediatric cases of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis with brain lesions consistent with multiple sclerosis (MS)
Background: NMDAR encephalitis is a neurologic disorder involving psychiatric symptoms, movement disorders, sleep disorders, seizures and autonomic dysfunction in conjunction with NMDAR antibodies. There are reports in the literature of cases of NMDAR encephalitis who later develop relapsing remitting multiple sclerosis (RRMS), bringing into question a potential underlying link between the two disease processes.
Methods: Details regarding the patients' clinical courses were obtained by chart review.
Results: The first patient had subacute onset of psychiatric symptoms and memory difficulties, then progressed to seizure activity. She was found to have positive NMDAR antibodies in both serum and cerebrospinal fluid (CSF) and was treated for NMDAR encephalitis with minimal residual deficits. Initial magnetic resonance imaging (MRI) of brain showed both enhancing and nonenhancing periventricular lesions typical of those seen in MS. These lesions either improved or resolved on subsequent imaging. The second patient initially presented with optic neuritis with optic nerve enhancement on MRI. He then clinically progressed to develop catatonia, hallucinations, and seizure activity with positive serum and CSF NMDAR antibodies. After he was treated for NMDAR encephalitis and gradually recovered, he developed asymptomatic periventricular enhancing and T2 hyperintense brain lesions typically seen in patients with MS.
Conclusions: These two cases of NMDAR encephalitis with MS-like brain lesions illustrate a possibly meaningful association between these disorders, and argue for further investigation into potential common pathophysiological pathways.
Disclosure: Lydia Marcus: nothing to disclose
Jayne Ness: nothing to disclose

Abstract: EP1331

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Paediatric MS

Objective: To examine two pediatric cases of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis with brain lesions consistent with multiple sclerosis (MS)
Background: NMDAR encephalitis is a neurologic disorder involving psychiatric symptoms, movement disorders, sleep disorders, seizures and autonomic dysfunction in conjunction with NMDAR antibodies. There are reports in the literature of cases of NMDAR encephalitis who later develop relapsing remitting multiple sclerosis (RRMS), bringing into question a potential underlying link between the two disease processes.
Methods: Details regarding the patients' clinical courses were obtained by chart review.
Results: The first patient had subacute onset of psychiatric symptoms and memory difficulties, then progressed to seizure activity. She was found to have positive NMDAR antibodies in both serum and cerebrospinal fluid (CSF) and was treated for NMDAR encephalitis with minimal residual deficits. Initial magnetic resonance imaging (MRI) of brain showed both enhancing and nonenhancing periventricular lesions typical of those seen in MS. These lesions either improved or resolved on subsequent imaging. The second patient initially presented with optic neuritis with optic nerve enhancement on MRI. He then clinically progressed to develop catatonia, hallucinations, and seizure activity with positive serum and CSF NMDAR antibodies. After he was treated for NMDAR encephalitis and gradually recovered, he developed asymptomatic periventricular enhancing and T2 hyperintense brain lesions typically seen in patients with MS.
Conclusions: These two cases of NMDAR encephalitis with MS-like brain lesions illustrate a possibly meaningful association between these disorders, and argue for further investigation into potential common pathophysiological pathways.
Disclosure: Lydia Marcus: nothing to disclose
Jayne Ness: nothing to disclose

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