Abstracts

Rationale: To review the clinical features of Anti-NMDAR in an eight year old boy with seizures, dyskinesis, choreiform movement, and abrupt cognitive/speech regression accompanied by fever.Methods: An eight year old male presented with acute onset of headache, lethargy, fever and seizures. Initial spinal tap showed WBC of 318 (37% polys), protein 167, glucose 67, and negative bacterial cultures. PCR for HSV was negative. CSF was positive for anti-NMDA receptor antibodies. Brain MRI showed subtle cortical edema. The patient was treated with IV steroids, plasmapheresis, IVIG, and Rituxamab. He developed choreiform movements in the course of his illness. At 15 months post treatment he is ambulatory without ataxia, takes oral feedings and his seizures are under good control with a normal EEG. However he continues to have marked cognitive and language impairments. Results: Anti-NMDAR antibodies are more commonly associated with ovarian teratoma. However, anti-NMDAR antibodies are detected in 40% of children who present with encephalitis. The complex clinical features of this disorder include mental status changes, cognitive regression, seizures, and dyskinetic motor function. Multi-system symptoms can occur. Recovery, especially to normal cognitive function, may be lengthy.Conclusions: Testing for NMDAR antibodies should be considered in the diagnostic work up of children who present with symptoms of encephalitis.