Anti-NMDA receptor autoimmune encephalitis associated with ovarian teratoma: A case series and literature review

Abstract

Autoimmune encephalitis is a group of disorders characterized by symptoms of dysfunction of the limbic and extra-limbic systems that occur in association with antibodies against intracellular antigens, synapses, or proteins located on the surface of nerve cells. Anti-NMDA (N-methyl-D-aspartate) receptor encephalitis was first described in 2007 and has become one of the most commonly recognized autoimmune encephalitides. The disease is predominantly female (81%) and affects young patients (37% <18 years old, 95% <45 years old), with up to 58% of women over 18 years old having ovarian teratoma. Clinical symptoms of anti-NMDA receptor encephalitis include psychiatric disorders (anxiety, agitation, bizarre behavior, hallucinations, delusions, and memory impairment); seizures and epileptic states; and other neurologic symptoms (muscle tone abnormalities, eye movement disorders, and central ventilatory disorders). Diagnosis of this condition can be difficult due to the non-specific nature of the symptoms, often leading to delays in appropriate treatment. Early diagnosis and timely treatment of anti-NMDA receptor encephalitis, especially in young women with ovarian teratoma, has significantly improved the chances of full recovery and improved reproductive health outcomes for patients.

Keywords: anti‐NDMA receptor antibodies; anti‐NMDA receptor encephalitis; autoimmune encephalitis; encephalitis; immunoglobulin; ovarian teratoma.

FIGURE 1

Overview of treatment. NMDAR, N‐methyl‐D‐aspartate receptor.

CHART 1

Clinical outcomes after 24 months of follow‐up.