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Updated: Jan 17, 2026
Induction and Diverse Assessment Indicators of Experimental Autoimmune Encephalomyelitis
Published on: September 9, 2022
A decade of diagnostic uncertainty: from neurodevelopmental disorders to the discovery of autoimmune encephalitis
Vykuntaraju K Gowda1, Archana Varghese2, Maria P Varghese3
1Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India drknvraju08@gmail.com.
Insights
A child with unexplained neuropsychiatric symptoms and seizures was diagnosed with anti-N-methyl-D-aspartate receptor encephalitis after extensive investigations. Immunotherapy led to partial clinical improvement, underscoring the need for re-evaluation in complex pediatric cases.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Developmental Neuroscience
Background:
- Recurrent paroxysmal events, behavioral changes, and involuntary movements in early childhood can present diagnostic challenges.
- A history of febrile illness followed by prolonged seizures and developmental regression can precede complex neuropsychiatric conditions.
- Previous diagnoses included intellectual disability, autism spectrum disorder, attention deficit hyperactivity disorder, and seizure disorder, but remained inconclusive.
Purpose of the Study:
- To present a case report of an early adolescent girl with a complex, long-standing neuropsychiatric and epilepsy presentation.
- To highlight the diagnostic process and eventual identification of anti-N-methyl-D-aspartate receptor encephalitis.
- To emphasize the importance of reconsidering diagnoses in pediatric patients with unexplained neurological and behavioral symptoms.
Main Methods:
- Detailed clinical history collection and neurological examination.
- Extensive investigations including neuroimaging and laboratory tests.
- Re-evaluation in early adolescence leading to detection of intrathecal N-methyl-D-aspartate receptor antibodies and oligoclonal bands.
Main Results:
- The patient exhibited recurrent seizures, behavioral changes, involuntary movements, and developmental regression since toddlerhood.
- Initial extensive investigations did not yield a definitive diagnosis.
- Confirmation of intrathecal N-methyl-D-aspartate receptor antibodies and type 2 oligoclonal bands established the diagnosis of autoimmune encephalitis.
- Treatment with methylprednisolone, rituximab, and intravenous immunoglobulin resulted in partial clinical improvement over 4 months.
Conclusions:
- Anti-N-methyl-D-aspartate receptor encephalitis should be considered in children with unexplained, evolving neuropsychiatric symptoms and seizures.
- Re-evaluation and advanced immunological testing are crucial for diagnosing challenging pediatric neurological disorders.
- Early diagnosis and immunotherapy can lead to partial recovery in patients with autoimmune encephalitis.
Abstract:
This case report describes an early adolescent girl who began experiencing recurrent paroxysmal events, behavioural changes and involuntary body movements from toddler age, shortly after a febrile illness. Prolonged seizures and developmental regression followed the febrile episode. Although she regained most of her milestones, she continued to have seizures over the years and developed stereotypic hand movements, emotional instability and hyperactivity. Despite extensive investigations, a definitive diagnosis remained elusive. She was initially diagnosed with intellectual disability, autism spectrum disorder, attention deficit hyperactivity disorder and seizure disorder. However, re-evaluation in early adolescence confirmed the presence of intrathecal N-methyl-D-aspartate receptor antibodies and type 2 oligoclonal bands, thereby establishing the diagnosis. The patient was treated with a combination of immunotherapies, including methylprednisolone, rituximab and intravenous immunoglobulin, with partial clinical improvement observed over 4 months of follow-up. This case highlights the importance of reconsidering the diagnosis in children presenting with unexplained neuropsychiatric symptoms and seizures.
