B-58Neuropsychological and Neurobehavioral Sequelae of Anti-NMDAR Encephalitis: Three Case Studies.

OBJECTIVE: Research on the neurocognitive profile of the autoimmune disorder anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is limited. The current case studies contribute to existing knowledge by investigating the neuropsychological sequelae of three patients, two of which are male, diagnosed with anti-NMDAR encephalitis during the acute rehabilitation phase.

METHOD: Two patients with confirmed anti-NMDAR encephalitis were assessed using a battery of neuropsychological tests. Another patient, also confirmed anti-NMDAR encephalitis, was unable to be formally assessed due to persisting psychiatric dysregulation. Patient 1 was a 19-year-old, African-American female, with a previous medical history of seizures, diagnosed with anti-NMDAR encephalitis secondary to an ovarian teratoma. Treatment included steroids, laproscopic surgery, anti-virals, anti-psychotics, anti-epileptics, and intravenous immunoglobin. Patient 2 was a 30-year-old, Caucasian male, with no previous medical history, admitted with new-onset seizures, right middle cerebral artery territory ischemic stroke, and eventual anti-NMDAR encephalitis. Treatment included steroids, anti-virals, anti-depressants, and anti-epileptics. Patient 3 was a 41-year-old, African-American male with a previous medical history of hypertension, cholesterol, and hernias. Treatment included alkylating agents, mood stabilizers, and anti-epileptics.

RESULTS: Fluctuating neurobehavioral and psychiatric disturbances impacted acute rehabilitation treatment in these patients. Persisting diffuse cognitive dysfunction with prominent impairments in memory and executive functioning was demonstrated in the two patients who were formally assessed and observed in the third patient.

CONCLUSION(S): Anti-NMDAR encephalitis produces persistent cognitive dysfunction in males and females and impacts their neurobehavioral presentation during acute rehabilitation. Neuropsychological assessment of patients with anti-NMDAR encephalitis significantly assists with developing targeted interventions for neurorehabilitative treatment.