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<p>Recently, the incidence of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis has been increasing. Characterized by frequent epileptic seizures, this condition threatens patients’ lives. Anti-NMDAR encephalitis is an autoimmune disorder affecting the central nervous system. In our case, a 21-year-old female who experienced four episodes of convulsions within 2&#xa0;days. Seizures were manifested as loss of consciousness, upward eye deviation, jaw clenching, and limb rigidity, each resolving spontaneously within 2–5&#xa0;min. Neurological examination was unremarkable, head MRI demonstrated bilateral cerebral white matter hyperintensities. Cerebrospinal fluid (CSF) analysis showed normal routine and biochemical parameters. Anti-NMDA receptor antibody IgG was detected at titers of 1:10 in CSF and 1:32 in serum. Pelvic MRI revealed a cystic-solid mass, which was surgically resected and pathologically confirmed the presence of ovarian teratoma. Following treatment with intravenous immunoglobulin, methylprednisolone, and sodium valproate, the patient’s condition improved, and the seizures resolved. Fourteen days postoperatively, seizure recurrence occurred. Repeat CSF analysis showed anti-NMDAR antibody IgG titer of 1:3.2, with a corresponding serum titer of 1:10. Plasma exchange therapy led to clinical improvement, allowing for successful discharge. Previously, the abovementioned phenomenon was described as poor response to first-line immunotherapy; however, the underlying mechanisms remain elusive, potentially contributing to elevated mortality. We first proposed the concept of “delayed encephalopathy in anti-NMDAR encephalitis,” defined as the early recurrence of epileptic seizures following completion of first-line immunotherapy. This phenomenon linked to the ambiguity surrounding clinical treatment endpoints. Establishing antibody thresholds could help define clearer treatment endpoints and reduce recurrence risk.</p>

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Recurrent Epilepsy 14 Days After Surgery in Teratoma-Associated Anti-NMDAR Encephalitis: A Case Report

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年6月3日

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  • Rong Deng,
  • Xiaoxue Tan,
  • Jinyan Tian,
  • Shiyu Tian,
  • Baiyi Liu,
  • Jie He,
  • Xiaojuan Wang,
  • Yuegao Liu

摘要

Recently, the incidence of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis has been increasing. Characterized by frequent epileptic seizures, this condition threatens patients’ lives. Anti-NMDAR encephalitis is an autoimmune disorder affecting the central nervous system. In our case, a 21-year-old female who experienced four episodes of convulsions within 2 days. Seizures were manifested as loss of consciousness, upward eye deviation, jaw clenching, and limb rigidity, each resolving spontaneously within 2–5 min. Neurological examination was unremarkable, head MRI demonstrated bilateral cerebral white matter hyperintensities. Cerebrospinal fluid (CSF) analysis showed normal routine and biochemical parameters. Anti-NMDA receptor antibody IgG was detected at titers of 1:10 in CSF and 1:32 in serum. Pelvic MRI revealed a cystic-solid mass, which was surgically resected and pathologically confirmed the presence of ovarian teratoma. Following treatment with intravenous immunoglobulin, methylprednisolone, and sodium valproate, the patient’s condition improved, and the seizures resolved. Fourteen days postoperatively, seizure recurrence occurred. Repeat CSF analysis showed anti-NMDAR antibody IgG titer of 1:3.2, with a corresponding serum titer of 1:10. Plasma exchange therapy led to clinical improvement, allowing for successful discharge. Previously, the abovementioned phenomenon was described as poor response to first-line immunotherapy; however, the underlying mechanisms remain elusive, potentially contributing to elevated mortality. We first proposed the concept of “delayed encephalopathy in anti-NMDAR encephalitis,” defined as the early recurrence of epileptic seizures following completion of first-line immunotherapy. This phenomenon linked to the ambiguity surrounding clinical treatment endpoints. Establishing antibody thresholds could help define clearer treatment endpoints and reduce recurrence risk.