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Glucocorticoid-dependent multiple sclerosis overlapping anti-NMDA receptor encephalitis: a case report and literature

Bo Yang1, Nengwei Yu2

  • 1Department of Center for Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|September 18, 2023
PubMed
Abstract

Insights

This case highlights the complex overlap between anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and multiple sclerosis (MS). Recurrent symptoms and atypical MRI findings underscore the need for long-term monitoring and individualized treatment strategies.

Area of Science:

  • Neuroimmunology
  • Neurology
  • Demyelinating Diseases

Background:

  • Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and multiple sclerosis (MS) share overlapping features.
  • The pathogenesis and clinical characteristics of this overlap remain incompletely understood.

Observation:

  • A 33-year-old woman presented with diplopia and sensory ataxia, diagnosed with anti-NMDAR encephalitis based on positive CSF antibodies and demyelinating lesions on MRI.
  • Despite initial treatment with immunotherapy, she experienced relapses with recurrent demyelinating lesions, positive oligoclonal bands, and symptoms suggestive of MS.
  • The patient demonstrated a significant, albeit temporary, response to glucocorticoids, with disease recurrence upon initiation of disease-modifying therapies.

Findings:

  • The patient exhibited atypical MRI findings and immunological markers characteristic of both anti-NMDAR encephalitis and MS.
  • Recurrence of symptoms and lesions occurred despite standard immunomodulatory treatments, indicating disease insensitivity.
  • A notable dependency on glucocorticoids for symptom control was observed.

Implications:

  • This case underscores the diagnostic and therapeutic challenges in overlapping anti-NMDAR encephalitis and MS.
  • Long-term follow-up, dynamic antibody monitoring, and serial MRI are essential for managing these complex cases.
  • The patient's glucocorticoid dependency may offer insights into treating refractory cases of recurrent overlapping encephalitis and MS, potentially guiding alternative therapeutic strategies.
Keywords:
Anti-NMDA receptor encephalitisCase reportGlucocorticoid-dependentMultiple sclerosis

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