PMC6336627_01
Clinical course. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis manifesting as seizures and abnormal behavior. Treatment with anticonvulsant and sedative drugs was started immediately along with steroid pulse therapy (a total of 2 cycles) and plasmapheresis (a total of 7 sessions). However, these treatments did not adequately control the repeated seizures and abnormal behavior. The seizures and abnormal behavior promptly disappeared with the addition of oral perampanel on day 22 of hospitalization. NMDAR = N-methyl-D-aspartate receptor.
medi-98-e14033-g001.jpg
PMC6336627_01_medi-98-e14033-g001.jpg
F1
However, while eating lunch with her mother at a restaurant at 2:00 PM on March 29, she developed sudden generalized tonic-clonic seizures with upward rolling of the eyes, limbs extended, teeth clenching, and altered consciousness (Fig. 1). Soon after that, she began having a tonic-clonic seizure with upward rolling of the eyes and limbs extended, and was brought to the previous hospital by ambulance and admitted (Fig. 1). After transfer, administration of acyclovir and levetiracetam 1 g/day by intravenous drip was continued, and lamotrigine was switched to oral carbamazepine (Fig. 1).
Brain MRI and EEG. Plain head MRI performed on day 2 of hospitalization was unremarkable, and no spike wave was detected on EEG on day 6. EEG = electroencephalography, FLAIR = fluid attenuated inversion recovery, MRI = magnetic resonance imaging, Rt. = right.
medi-98-e14033-g002.jpg
PMC6336627_01_medi-98-e14033-g002.jpg
F2
Plain head MRI performed that day was unremarkable (Fig. 2), and plain pelvic MRI performed on day 3 showed no ovarian tumors or lymph node swelling. Another EEG performed on day 6 still showed no spike wave (Fig. 2), but the patient's previous doctor reported that cerebrospinal fluid had tested positive for anti-NMDAR antibody.