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Anti-NMDA receptor encephalitis is increasingly being recognized as one of the causes of non-infectious encephalitis. Here, we report four female patients with this disease who had a different clinical course and outcome. The patients are all female aged below 45 years old, especially teenagers, and it is usually accompanied by ovarian teratoma. The disease often starts with a prodromal phase of flu-like symptoms, followed by progression into major typical symptoms: prominent psychiatric disorder or bizarre behavior, seizure, abnormal movement, dysfunctional speech, memory deficit, alteration of consciousness and autonomic instability. Recognizing this syndrome and confirming with antibody testing will more likely lead to a favorable outcome. Prompt immunotherapy should be initiated, common protocols are high doses of steroids, plasmapheresis and intravenous immunoglobulin. However, the treatment protocol and long-term management is still not established.
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2. Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 2016;15:391-404.
3. Dalmau PJ, Lancaster E, Martinez-Hernandez E , et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011;10:63-74.
4. Barry H, Byrne S, Barrett E, et al. Anti-N-methyl-D-aspartate receptor encephalitis: review of clinical presentation, diagnosis and treatment. Br J Psych Bull 2015;39:19-23.
5. Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDAreceptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008; 7:1091-8.
6. Saraya A, Mahavihakanont A, Shuangshoti S, et al. Autoimmune causes of encephalitis syndrome in Thailand: prospective study of 103 patients. BMC Neurol 2013;13:150.
7. Schmitt SE, Pargeon K, Frechette ES, et al. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology 2012;79:1094-100.
8. Limotai C, Denlertchaikul C, Saraya AW, et al. Predictive values and specificity of electroencephalographic findings in autoimmune encephalitis diagnosis. Epilepsy Behav 2018;84: 29-36.
9. Gresa-Arribas N, Titulaer MJ, Torrents A, et al: Antibody titers at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol. 2014;13: 167-77.
10. Kelly BP, Patel SC, Marin HL, et al: Autoimmune encephalitis: pathophysiology and imaging review of an overlooked diagnosis. AJNR Am J Neuroradiol 2017;38: 1070-8.
11. 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 :157-65.