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Anti-N-methyl-D-aspartate-glutamic-receptor encephalitis presenting as paroxysmal exercise-induced foot weakness

Angelo Labate1, Aldo Quattrone, Josep Dalmau

  • 1Institute of Neurology University Magna Graecia, Catanzaro, Italy.

Movement Disorders : Official Journal of the Movement Disorder Society
|May 31, 2013
PubMed
Abstract

Insights

Anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis can present with unusual movement disorders. This case highlights exercise-induced weakness as an early symptom of oligosymptomatic NMDAR encephalitis.

Area of Science:

  • Neurology
  • Immunology

Background:

  • Anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is an autoimmune condition.
  • Patients often exhibit complex abnormal movements early in the disease course.

Purpose of the Study:

  • To describe a unique presentation of anti-NMDAR encephalitis.
  • To expand the understanding of movement disorders associated with this condition.

Main Methods:

  • Case report of a 17-year-old male.
  • Clinical presentation, neurological examination, ictal video-polygraphy, MRI, and laboratory tests including NMDAR antibody detection.
  • Treatment with immunotherapy (methylprednisolone and immunoglobulins).

Main Results:

  • The patient presented with paroxysmal exercise-induced right foot weakness, followed by hyperthermia and status epilepticus.
  • Normal neurological examination between attacks and normal EEG during episodes.
  • Positive NMDAR antibodies in serum and cerebrospinal fluid.

Conclusions:

  • Exercise-induced weakness can be an early, oligosymptomatic manifestation of anti-NMDAR encephalitis.
  • This case broadens the spectrum of movement abnormalities seen in NMDAR encephalitis.

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