Anti-NMDAR encephalitis complicating pregnancy

Pract Neurol. 2019 Apr;19(2):131-135. doi: 10.1136/practneurol-2018-002042. Epub 2018 Oct 10.

Abstract

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis was first reported in 2005 in four patients with ovarian teratomas; there have been many further cases reported since the antigen for the NMDAR antibody was confirmed in 2007. Patients characteristically have a well-defined set of features, characterised by psychiatric disturbance, seizures and cognitive disturbance, followed by movement disorders, disorders of consciousness and dysautonomia. To date, 14 cases of NMDAR encephalitis have been described in the context of pregnancy. We report a case of NMDAR encephalitis in a 34-year-old woman at 8 weeks' gestation. She had a turbulent clinical course and was initially admitted to a psychiatric unit. She was successfully treated with first-line immunomodulatory therapies and surgical resection of an ovarian teratoma. Following discharge she delivered a healthy baby and made a complete clinical recovery.

Keywords: NMDA; epilepsy; neuroimmunology; obstetrics; psychiatry.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / complications*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnosis
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / drug therapy
  • Female
  • Humans
  • Ovarian Neoplasms / complications
  • Ovarian Neoplasms / diagnosis
  • Ovarian Neoplasms / therapy*
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications / drug therapy*
  • Receptors, N-Methyl-D-Aspartate / immunology
  • Seizures / complications*
  • Seizures / diagnosis
  • Seizures / drug therapy
  • Teratoma / complications
  • Teratoma / diagnosis
  • Teratoma / therapy*
  • Treatment Outcome

Substances

  • Receptors, N-Methyl-D-Aspartate

Supplementary concepts

  • Teratoma, Ovarian