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A Simple Cell-based Immunofluorescence Assay to Detect Autoantibody Against the N-Methyl-D-Aspartate NMDA Receptor in Blood
Published on: January 9, 2018
Neurocritical care for Anti-NMDA receptor encephalitis
1Division of Pediatric Neurology, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Insights
This review details anti-N-methyl-d-aspartate (NMDA) receptor encephalitis, a condition affecting young adults and children. It outlines the five clinical stages and neurocritical care strategies for managing acute presentations in intensive care units.
Area of Science:
- Neurology
- Immunology
- Critical Care Medicine
Background:
- Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis is an autoimmune disorder with distinct clinical manifestations.
- It predominantly affects young adults and children, presenting a complex diagnostic and management challenge.
Purpose of the Study:
- To review the clinical presentations of anti-NMDA receptor encephalitis during its acute phase.
- To outline neurocritical care strategies for managing patients in intensive care units.
Main Methods:
- This is a review article summarizing existing literature on anti-NMDA receptor encephalitis.
- Focus is on clinical staging, characteristic symptoms, and intensive care interventions.
Main Results:
- The disease progresses through five distinct clinical stages: prodromal, psychotic/seizure, unresponsive/catatonic, hyperkinetic, and recovery.
- Acute presentations include refractory seizures, autonomic dysfunction, hypoventilation, cardiac arrhythmias, and hyperkinetic crisis.
- Patients often require mechanical ventilation due to decreased consciousness and central hypoventilation.
Conclusions:
- Effective management of anti-NMDA receptor encephalitis requires prompt recognition of its clinical stages and critical presentations.
- Symptom-guided therapies and intensive care are crucial for improving patient prognosis.
- Pediatric intensive care units are recommended for children with significant neurological symptoms.
Abstract:
In this review, we summarize the clinical presentations of the acute stage of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis and the neurocritical care strategy in intensive care units. Anti-NMDA receptor encephalitis has characteristic clinical features and is predominantly seen in young adults and children. Most patients have five stages of clinical presentation, including a prodromal phase, psychotic and/or seizure phase, unresponsive and/or catatonic phase, hyperkinetic phase, and gradual recovery phase. The clinical course usually begins with viral infection-like symptoms that last for up to 2 weeks (prodromal phase), followed by the rapid development of schizophrenia-like psychiatric symptoms and seizures (psychotic and seizure phase). Patients may have a decreased level of consciousness with central hypoventilation, frequently requiring mechanical ventilation. In the subsequent hyperkinetic phase, patients present with orofacial-limb dyskinesia and autonomic instability. Children with significant neurological symptoms of anti-NMDA receptor encephalitis should initially be managed in a pediatric intensive care unit. The acute critical presentations are, refractory seizures, autonomic dysfunction, hypoventilation, cardiac arrhythmia, and hyperkinetic crisis. Symptom-guided therapies and critical care are necessary in the acute stage to improve the prognosis.
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