Document Detail

Adjunct therapeutic plasma exchange for anti-N-methyl-D-aspartate receptor antibody encephalitis: a case report and review of literature.
MedLine Citation:
PMID:  22038876     Owner:  NLM     Status:  MEDLINE    
Encephalitis associated with autoantibodies directed against the N-methyl-D-aspartate receptor (NMDAR) is usually a paraneoplastic syndrome that presents in young females with ovarian teratomas. We report a case of a previously healthy 14-year-old girl with sudden-onset paranoia, hallucinations, hyperactivity, increased speech, decreased sleep, seizures, and violent behavior deteriorating to catatonia. Her cerebrospinal fluid tested positive for anti-NMDAR antibodies. She was treated with five sessions of therapeutic plasma exchange (TPE) after having failed therapy with antibiotics, intravenous steroids, intravenous immunoglobulin (IVIG), one dose of rituximab, and seven sessions of electroconvulsive therapy (ECT). The American Society for Apheresis assigns a Category III (Grade 2C) recommendation for TPE in paraneoplastic neurologic syndromes; however, apheresis specifically for anti-NMDAR encephalitis has not been well studied. Literature review revealed two case reports describing outstanding improvement in patients with anti-NMDAR encephalitis following TPE. We report no improvement in our patient's symptoms after plasma exchange and discuss possible reasons for why it failed along with review of the literature.
M Kamran Mirza; Jennifer Pogoriler; Kristen Paral; Vijayalakshmi Ananthanarayanan; Saptarshi Mandal; Abdul Mazin; Beverly Baron; Elie Richa
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2011-10-29
Journal Detail:
Title:  Journal of clinical apheresis     Volume:  26     ISSN:  1098-1101     ISO Abbreviation:  J Clin Apher     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-14     Completed Date:  2012-04-17     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8216305     Medline TA:  J Clin Apher     Country:  United States    
Other Details:
Languages:  eng     Pagination:  362-5     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Wiley Periodicals, Inc.
Department of Pathology, Biological Sciences Division, Section of Blood Bank and Transfusion Medicine, The University of Chicago, Illinois, USA.
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MeSH Terms
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnosis,  psychology,  therapy*
Catatonia / therapy
Combined Modality Therapy
Plasma Exchange*
Treatment Failure
Comment In:
J Clin Apher. 2012;27(4):227-8   [PMID:  22411418 ]

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