Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-03T00:49:33.818Z Has data issue: false hasContentIssue false

Chapter 20 - Psychiatric Manifestations of Autoimmune Encephalitis

from Section 4 - Autoimmunity in Neurological and Psychiatric Diseases

Published online by Cambridge University Press:  27 January 2022

Josep Dalmau  and
Francesc Graus
Josep Dalmau
Affiliation:
Universitat de Barcelona
Francesc Graus
Affiliation:
Universitat de Barcelona
Get access

Summary

This chapter focuses on how to recognize anti-NMDAR receptor encephalitis at early stages, when most patients have pure or predominant psychiatric symptoms. We also discuss the differential diagnosis with schizophrenia, acute-onset psychosis, and neuroleptic malignant syndrome, and formulate a general diagnostic and treatment approach to psychiatric symptoms. Anti-NMDAR encephalitis manifests with a wide range of psychiatric symptoms, indistinguishable from that of schizophrenia and other psychiatric diseases, and with a spectrum of psychiatric manifestations that varies according to the stage of the disease. However, >95% of patients develop at early stages of the disease (days or weeks after onset of psychiatric symptoms or concomitant with them) neurological symptoms such as seizures, decreased verbal output, abnormal movements, or dysautonomia. This combination of symptoms usually suggest the diagnosis and prompts NMDAR antibody testing, which should be performed in CSF. The symptomatic treatment of the psychiatric manifestations is largely based on expert opinions, suggesting that conventional antipsychotic drugs should be avoided due to the susceptibility of these patients to developing neuroleptic malignant syndrome. It is unclear whether atypical antipsychotics are associated with lower frequency of these adverse effects, but they are more frequently used. A study suggested that all types of antipsychotic drugs carry a similar enhanced risk of adverse effects, although other studies, and our own experience, suggest that atypical antipsychotics are associated with less adverse effects.

Keywords

Autoimmune encephalitisautoimmune psychosisanti-NMDA receptor encephalitisschizophreniapsychosis
Type
Chapter
Information
Autoimmune Encephalitis and Related Disorders of the Nervous System , pp. 527 - 544
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Vitaliani, R, Mason, W, Ances, B, et al. Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol 2005;58:594–604.CrossRefGoogle ScholarPubMed
Dalmau, J, Armangue, T, Planaguma, J, et al. An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models. Lancet Neurol 2019;18:1045–1057.Google Scholar
Kayser, MS, Titulaer, MJ, Gresa-Arribas, N, Dalmau, J. Frequency and characteristics of isolated psychiatric episodes in anti-N-methyl-D-aspartate receptor encephalitis. JAMA Neurol 2013;70:1133–1139.CrossRefGoogle ScholarPubMed
Chapman, MR, Vause, HE. Anti-NMDA receptor encephalitis: diagnosis, psychiatric presentation, and treatment. Am J Psychiatry 2011;168:245–251.CrossRefGoogle ScholarPubMed
Warren, N, Siskind, D, O’Gorman, C. Refining the psychiatric syndrome of anti-N-methyl-D-aspartate receptor encephalitis. Acta Psychiatr Scand 2018;138:401–408.CrossRefGoogle ScholarPubMed
Sarkis, RA, Coffey, MJ, Cooper, JJ, Hassan, I, Lennox, B. Anti-N-methyl-D-aspartate receptor encephalitis: a review of psychiatric phenotypes and management considerations – a report of the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 2019;31:137–142.CrossRefGoogle ScholarPubMed
Al-Diwani, A, Handel, A, Townsend, L, et al. The psychopathology of NMDAR-antibody encephalitis in adults: a systematic review and phenotypic analysis of individual patient data. Lancet Psychiatry 2019;6:235–246.Google Scholar
Titulaer, MJ, McCracken, L, Gabilondo, I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013;12:157–165.Google Scholar
Dalmau, J, Gleichman, AJ, Hughes, EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008;7:1091–1098.CrossRefGoogle ScholarPubMed
Irani, SR, Bera, K, Waters, P, et al. N-methyl-D-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexes. Brain 2010;133:1655–1667.Google Scholar
Viaccoz, A, Desestret, V, Ducray, F, et al. Clinical specificities of adult male patients with NMDA receptor antibodies encephalitis. Neurology 2014;82:556–563.CrossRefGoogle ScholarPubMed
Florance, NR, Davis, RL, Lam, C, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol 2009;66:11–18.CrossRefGoogle ScholarPubMed
Armangue, T, Titulaer, MJ, Malaga, I, et al. Pediatric anti-N-methyl-D-aspartate receptor encephalitis: clinical analysis and novel findings in a series of 20 patients. J Pediatr 2013;162:850–856.CrossRefGoogle Scholar
Mohammad, SS, Jones, H, Hong, M, et al. Symptomatic treatment of children with anti-NMDAR encephalitis. Dev Med Child Neurol 2016;58:376–384.CrossRefGoogle ScholarPubMed
Dale, RC, Irani, SR, Brilot, F, et al. N-methyl-D-aspartate receptor antibodies in pediatric dyskinetic encephalitis lethargica. Ann Neurol 2009;66:704–709.CrossRefGoogle ScholarPubMed
Schumacher, LT, Mann, AP, MacKenzie, JG. Agitation management in pediatric males with anti-N-methyl-D-aspartate receptor encephalitis. J Child Adolesc Psychopharmacol 2016;26:939–943.Google Scholar
Florance-Ryan, N, Dalmau, J. Update on anti-N-methyl-D-aspartate receptor encephalitis in children and adolescents. Curr Opin Pediatr 2010;22:739–744.Google Scholar
Lejuste, F, Thomas, L, Picard, G, et al. Neuroleptic intolerance in patients with anti-NMDAR encephalitis. Neurol Neuroimmunol Neuroinflamm 2016;3:e280.Google Scholar
Warren, N, Grote, V, O’Gorman, C, Siskind, D. Electroconvulsive therapy for anti-N-methyl-d-aspartate (NMDA) receptor encephalitis: a systematic review of cases. Brain Stimul 2019;12:329–334.CrossRefGoogle ScholarPubMed
Ariño, H, Muñoz-Lopetegi, A, Martinez-Hernandez, E, et al. Sleep disorders in anti-NMDAR encephalitis. Neurology 2020;95:e671–e684.Google Scholar
Gibson, LL, Pollak, TA, Blackman, G, et al. The psychiatric phenotype of anti-NMDA receptor encephalitis. J Neuropsychiatry Clin Neurosci 2019;31:70–79.Google Scholar
Gine Serven, E, Boix Quintana, E, Martinez Ramirez, M, et al. Cycloid psychosis as a psychiatric expression of anti-NMDAR encephalitis: a systematic review of case reports accomplished with the authors’ cooperation. Brain Behav 2021;11:e01980.Google Scholar
Perris, C. A study of cycloid psychoses. Acta Psychiatr Scand Suppl 1974;253:1–77.Google ScholarPubMed
Brockington, IF, Perris, C, Kendell, RE, Hillier, VE, Wainwright, S. The course and outcome of cycloid psychosis. Psychol Med 1982;12:97–105.Google Scholar
Roliz A, Shah Y, Morse A, et al., Clinical features of paediatric and adult autoimmune encephalitis: A multicenter sample. Eur J Paediatr Neurol. 2021;30:82–87.CrossRefGoogle Scholar
Munoz-Lopetegi, A, Graus, F, Dalmau, J, Santamaria, J. Sleep disorders in autoimmune encephalitis. Lancet Neurol 2020;19:1010–1022.Google Scholar
Ochoa, S, Usall, J, Cobo, J, Labad, X, Kulkarni, J. Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophr Res Treatment 2012;2012:916198.CrossRefGoogle ScholarPubMed
Gresa-Arribas, N, Titulaer, MJ, Torrents, A, et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol 2014;13:167–177.Google Scholar
Sonderen, AV, Arends, S, Tavy, DLJ, et al. Predictive value of electroencephalography in anti-NMDA receptor encephalitis. J Neurol Neurosurg Psychiatry 2018;89:1101–1106.CrossRefGoogle ScholarPubMed
Schmitt, SE, Pargeon, K, Frechette, ES, et al. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology 2012;79:1094–1100.CrossRefGoogle Scholar
Peer, M, Pruss, H, Ben-Dayan, I, et al. Functional connectivity of large-scale brain networks in patients with anti-NMDA receptor encephalitis: an observational study. Lancet Psychiatry 2017;4:768–774.Google Scholar
Finke, C, Kopp, UA, Pajkert, A, et al. Structural hippocampal damage following anti-N-methyl-D-aspartate receptor encephalitis. Biol Psychiatry 2016;79:727–734.Google Scholar
Phillips, OR, Joshi, SH, Narr, KL, et al. Superficial white matter damage in anti-NMDA receptor encephalitis. J Neurol Neurosurg Psychiatry 2018;89:518–525.Google Scholar
Leypoldt, F, Buchert, R, Kleiter, I, et al. Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease. J Neurol Neurosurg Psychiatry 2012;83:681–686.CrossRefGoogle ScholarPubMed
Probasco, JC, Solnes, L, Nalluri, A, et al. Abnormal brain metabolism on FDG-PET/CT is a common early finding in autoimmune encephalitis. Neurol Neuroimmunol Neuroinflamm 2017;4:e352.Google Scholar
Endres, D, Perlov, E, Stich, O, et al. Hypoglutamatergic state is associated with reduced cerebral glucose metabolism in anti-NMDA receptor encephalitis: a case report. BMC Psychiatry 2015;15:186.Google Scholar
Heresco-Levy, U, Durrant, AR, Ermilov, M, et al. Clinical and electrophysiological effects of D-serine in a schizophrenia patient positive for anti-N-methyl-D-aspartate receptor antibodies. Biol Psychiatry 2015;77:e27–29.CrossRefGoogle Scholar
Sansing, LH, Tuzun, E, Ko, MW, et al. A patient with encephalitis associated with NMDA receptor antibodies. Nat Clin Pract Neurol 2007;3:291–296.CrossRefGoogle ScholarPubMed
Mohammad, SS, Wallace, G, Ramanathan, S, Brilot, F, Dale, RC. Antipsychotic-induced akathisia and neuroleptic malignant syndrome in anti-NMDAR encephalitis. Ann Clin Psychiatry 2014;26:297–298.Google Scholar
Wang, HY, Li, T, Li, XL, et al. Anti-N-methyl-D-aspartate receptor encephalitis mimics neuroleptic malignant syndrome: case report and literature review. Neuropsychiatr Dis Treat 2019;15:773–778.Google Scholar
Berg, A, Byrne, R, Coffey, BJ. Neuroleptic malignant syndrome in a boy with NMDA receptor encephalitis. J Child Adolesc Psychopharmacol 2015;25:368–371.CrossRefGoogle Scholar
Kiani, R, Lawden, M, Eames, P, et al. Anti-NMDA-receptor encephalitis presenting with catatonia and neuroleptic malignant syndrome in patients with intellectual disability and autism. BJPsych Bull 2015;39:32–35.Google Scholar
Rozier, M, Morita, D, King, M. Anti-N-methyl-D-aspartate receptor encephalitis: a potential mimic of neuroleptic malignant syndrome. Pediatr Neurol 2016;63:71–72.Google Scholar
Caroff, SN. Phenomenology and management of encephalitis. J Neuropsychiatry Clin Neurosci 2019;31:399.Google Scholar
Sarkis, RA. Risk of Neuroleptic malignant syndrome in encephalitides: response to Caroff. J Neuropsychiatry Clin Neurosci 2019;31:400.Google Scholar
Hughes, EG, Peng, X, Gleichman, AJ, et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci 2010;30:5866–5875.Google Scholar
Ladepeche, L, Dupuis, JP, Bouchet, D, et al. Single-molecule imaging of the functional crosstalk between surface NMDA and dopamine D1 receptors. Proc Natl Acad Sci USA 2013;110:18005–18010.Google Scholar
Grea, H, Bouchet, D, Rogemond, V, et al. Human autoantibodies against N-methyl-D-aspartate receptor modestly alter dopamine D1 receptor surface Dynamics. Front Psychiatry 2019;10:670.Google Scholar
Carceles-Cordon, M, Mannara, F, Aguilar, E, et al. NMDAR antibodies alter dopamine receptors and cause psychotic behavior in mice. Ann Neurol 2020;88:603–613.CrossRefGoogle ScholarPubMed
Kayser, MS, Dalmau, J. Anti-NMDA receptor encephalitis in psychiatry. Curr Psychiatry Rev 2011;7:189–193.Google Scholar
Baizabal-Carvallo, JF, Stocco, A, Muscal, E, Jankovic, J. The spectrum of movement disorders in children with anti-NMDA receptor encephalitis. Mov Disord 2013;28:543–547.CrossRefGoogle ScholarPubMed
Sunwoo, JS, Jung, DC, Choi, JY, et al. Successful treatment of refractory dyskinesia secondary to anti-N-methyl-D-aspartate receptor encephalitis with electroconvulsive therapy. J ECT 2016;32:e13–14.Google Scholar
Cooper, JJ, Afzal, KI. Safety of electroconvulsive therapy in 2 very young pediatric patients with catatonia related to anti-N-methyl-D-aspartate receptor encephalitis. J ECT 2019;35:216–217.Google Scholar
Moussa, T, Afzal, K, Cooper, J, et al. Pediatric anti-NMDA receptor encephalitis with catatonia: treatment with electroconvulsive therapy. Pediatr Rheumatol Online J 2019;17:8.CrossRefGoogle ScholarPubMed
Medina, M, Cooper, JJ. Refractory catatonia due to N-methyl-D-aspartate receptor encephalitis responsive to electroconvulsive therapy: the clinical use of the clock drawing test. J ECT 2017;33:223–224.Google Scholar
Matsumoto, T, Matsumoto, K, Kobayashi, T, Kato, S. Electroconvulsive therapy can improve psychotic symptoms in anti-NMDA-receptor encephalitis. Psychiatry Clin Neurosci 2012;66:242–243.Google Scholar
Braakman, HM, Moers-Hornikx, VM, Arts, BM, Hupperts, RM, Nicolai, J. Pearls & oysters: electroconvulsive therapy in anti-NMDA receptor encephalitis. Neurology 2010;75:e44–e46.CrossRefGoogle ScholarPubMed
Coffey, MJ, Cooper, JJ. Electroconvulsive therapy in anti-N-methyl-D-aspartate receptor encephalitis: a case report and review of the literature. J ECT 2016;32:225–229.Google Scholar
Creten, C, van der Zwaan, S, Blankespoor, RJ, et al. Late onset autism and anti-NMDA-receptor encephalitis. Lancet 2011;378:98.Google Scholar
Gonzalez-Valcarcel, J, Rosenfeld, MR, Dalmau, J. [Differential diagnosis of encephalitis due to anti-NMDA receptor antibodies]. Neurologia 2010;25:409–413.Google Scholar
Dalmau, J, Graus, F, Rosenblum, MK, Posner, JB. Anti-Hu-associated paraneoplastic encephalomyelitis/sensory neuronopathy: a clinical study of 71 patients. Medicine (Baltimore) 1992;71:59–72.CrossRefGoogle ScholarPubMed
Alamowitch, S, Graus, F, Uchuya, M, et al. Limbic encephalitis and small cell lung cancer. Clinical and immunological features. Brain 1997;120(Pt 6):923–928.Google Scholar
Dalmau, J, Graus, F, Villarejo, A, et al. Clinical analysis of anti-Ma2-associated encephalitis. Brain 2004;127:1831–1844.Google Scholar
Yu, Z, Kryzer, TJ, Griesmann, GE, et al. CRMP-5 neuronal autoantibody: marker of lung cancer and thymoma-related autoimmunity. Ann Neurol 2001;49:146–154.Google Scholar
Moss, HE, Liu, GT, Dalmau, J. Glazed (vision) and confused. Surv Ophthalmol 2009;55:169–173.CrossRefGoogle ScholarPubMed
Antoine, JC, Absi, L, Honnorat, J, et al. Antiamphiphysin antibodies are associated with various paraneoplastic neurological syndromes and tumors. Arch Neurol 1999;56:172–177.Google Scholar
Moon, J, Lee, ST, Shin, JW, et al. Non-stiff anti-amphiphysin syndrome: clinical manifestations and outcome after immunotherapy. J Neuroimmunol 2014;274:209–214.Google Scholar
Peterson, K, Rosenblum, MK, Kotanides, H, Posner, JB. Paraneoplastic cerebellar degeneration: I. A clinical analysis of 55 anti-Yo antibody-positive patients. Neurology 1992;42:1931–1937.Google Scholar
McKeon, A, Tracy, JA, Pittock, SJ, et al. Purkinje cell cytoplasmic autoantibody type 1 accompaniments: the cerebellum and beyond. Arch Neurol 2011;68:1282–1289.Google Scholar
Ances, BM, Vitaliani, R, Taylor, RA, et al. Treatment-responsive limbic encephalitis identified by neuropil antibodies: MRI and PET correlates. Brain 2005;128:1764–1777.Google Scholar
Hoftberger, R, van Sonderan, A, Leypoldt, F, et al. Encephalitis and AMPA receptor antibodies: novel findings in a case series of 22 patients. Neurology 2015;84:2403–2412.Google Scholar
Hoftberger, R, Titulaer, MJ, Sabater, L, et al. Encephalitis and GABAB receptor antibodies: novel findings in a new case series of 20 patients. Neurology 2013;81:1500–1506.Google Scholar
Lai, M, Huijbers, MG, Lancaster, E, et al. Investigation of LGI1 as the antigen in limbic encephalitis previously attributed to potassium channels: a case series. Lancet Neurol 2010;9:776–785.Google Scholar
Irani, SR, Alexander, S, Waters, P, et al. Antibodies to Kv1 potassium channel-complex proteins leucine-rich, glioma inactivated 1 protein and contactin-associated protein-2 in limbic encephalitis, Morvan’s syndrome and acquired neuromyotonia. Brain 2010;133:2734–2748.Google Scholar
van Sonderen, A, Arino, H, Petit-Pedrol, M, et al. The clinical spectrum of Caspr2 antibody-associated disease. Neurology 2016;87:521–528.Google Scholar
Spatola, M, Petit-Pedrol, M, Simabukuro, MM, et al. Investigations in GABAA receptor antibody-associated encephalitis. Neurology 2017;88:1012–1020.Google Scholar
Joubert, B, Kerschen, P, Zekeridou, A, et al. Clinical spectrum of encephalitis associated with antibodies against the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor: case series and review of the literature. JAMA Neurol 2015;72:1163–1169.Google Scholar
Lancaster, E, Lai, M, Peng, X, et al. Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol 2010;9:67–76.Google Scholar
Jeffery, OJ, Lennon, VA, Pittock, SJ, et al. GABAB receptor autoantibody frequency in service serologic evaluation. Neurology 2013;81:882–887.CrossRefGoogle ScholarPubMed
Arino, H, Armangue, T, Petit-Pedrol, M, et al. Anti-LGI1-associated cognitive impairment: presentation and long-term outcome. Neurology 2016;87:759–765.Google Scholar
Pollak, TA, Moran, N. Emergence of new-onset psychotic disorder following recovery from LGI1 antibody-associated limbic encephalitis. BMJ Case Rep 2017;2017:bcr2016218328.Google Scholar
Somers, KJ, Lennon, VA, Rundell, JR, et al. Psychiatric manifestations of voltage-gated potassium-channel complex autoimmunity. J Neuropsychiatry Clin Neurosci 2011;23:425–433.Google Scholar
Irani, SR, Pettingill, P, Kleopa, KA, et al. Morvan syndrome: clinical and serological observations in 29 cases. Ann Neurol 2012;72:241–255.Google Scholar
Spatola, M, Sabater, L, Planaguma, J, et al. Encephalitis with mGluR5 antibodies: symptoms and antibody effects. Neurology 2018;90:e1964–e1972.Google Scholar
Dale, RC, Merheb, V, Pillai, S, et al. Antibodies to surface dopamine-2 receptor in autoimmune movement and psychiatric disorders. Brain 2012;135:3453–3468.Google Scholar
Boronat, A, Gelfand, JM, Gresa-Arribas, N, et al. Encephalitis and antibodies to dipeptidyl-peptidase-like protein-6, a subunit of Kv4.2 potassium channels. Ann Neurol 2013;73:120–128.Google Scholar
Tobin, WO, Lennon, VA, Komorowski, L, et al. DPPX potassium channel antibody: frequency, clinical accompaniments, and outcomes in 20 patients. Neurology 2014;83:1797–1803.Google Scholar
Hara, M, Arino, H, Petit-Pedrol, M, et al. DPPX antibody-associated encephalitis: main syndrome and antibody effects. Neurology 2017;88:1340–1348.Google Scholar
Petit-Pedrol, M, Armangue, T, Peng, X, et al. Encephalitis with refractory seizures, status epilepticus, and antibodies to the GABAA receptor: a case series, characterisation of the antigen, and analysis of the effects of antibodies. Lancet Neurol 2014;13:276–286.Google Scholar
Pettingill, P, Kramer, HB, Coebergh, JA, et al. Antibodies to GABAA receptor alpha1 and gamma2 subunits: clinical and serologic characterization. Neurology 2015;84:1233–1241.Google Scholar
Gresa-Arribas, N, Planaguma, J, Petit-Pedrol, M, et al. Human neurexin-3alpha antibodies associate with encephalitis and alter synapse development. Neurology 2016;86:2235–2242.Google Scholar
Laurido-Soto, O, Brier, MR, Simon, LE, et al. Patient characteristics and outcome associations in AMPA receptor encephalitis. J Neurol 2019;266:450–460.Google Scholar
Armangue, T, Spatola, M, Vlagea, A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis. Lancet Neurol 2018;17:760–772.Google Scholar
Mohammad, SS, Sinclair, K, Pillai, S, et al. Herpes simplex encephalitis relapse with chorea is associated with autoantibodies to N-methyl-D-aspartate receptor or dopamine-2 receptor. Mov Disord 2014;29:117–122.Google Scholar
Hacohen, Y, Deiva, K, Pettingill, P, et al. N-methyl-D-aspartate receptor antibodies in post-herpes simplex virus encephalitis neurological relapse. Mov Disord 2014;29:90–96.Google Scholar
Armangue, T, Leypoldt, F, Malaga, I, et al. Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Ann Neurol 2014;75:317–323.Google Scholar
Leypoldt, F, Titulaer, MJ, Aguilar, E, et al. Herpes simplex virus-1 encephalitis can trigger anti-NMDA receptor encephalitis: case report. Neurology 2013;81:1637–1639.Google Scholar
Ma, J, Han, W, Jiang, L. Japanese encephalitis-induced anti-N-methyl-d-aspartate receptor encephalitis: a hospital-based prospective study. Brain Dev 2020;42:179–184.Google Scholar
Tian, M, Li, J, Lei, W, Shu, X. Japanese encephalitis virus-induced anti-N-methyl-D-aspartate receptor encephalitis: a case report and review of literature. Neuropediatrics 2019;50:111–115.Google Scholar
Schabitz, WR, Rogalewski, A, Hagemeister, C, Bien, CG. VZV brainstem encephalitis triggers NMDA receptor immunoreaction. Neurology 2014;83:2309–2311.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×