Adult anti-NMDA receptor encephalitis: Which physical and rehabilitation medicine program? Case reports and literature review.

OBJECTIVE: Anti-NMDA (N-Methyl-D-Aspartate) receptor encephalitis (NMDA-E) is the second cause of autoimmune encephalitis in adults. The objectives of this presentation are to describe the main clinical elements and rehabilitation specificities.

OBSERVATIONS: Three female inpatients (mean age: 25) present with moderate to severe behavioural and/or psychiatric disorders, seizures and presence of associated tumor in one patient. Presence of anti-NMDA antibodies in the cerebrospinal liquid confirmed diagnosis. Rehabilitation was focused on cognitive and behavioural remediation, dysphagia rehabilitation (2 patients) and on functional mobility improvement and regular psychiatric assessment. Functional outcome was satisfactory. Return to previous activities (high school and college) was obtained for 2 cases, respectively at 22 and 6 months of evolution.

DISCUSSION - CONCLUSION: Four cases with description of rehabilitation procedures are found in literature: 3 women (mean age: 25) benefit from specific rehabilitation program (physiotherapy, neuropsychology, and speech therapy) with medium-term improvement; and 1 young girl, with physical reconditioning and neuropsychology sessions, allowing return to high school with specific adaptations. Main features for E-NMDA rehabilitation combine neurocognitive and behavioral support. Regular psychiatric monitoring is necessary. Though functional prognosis is good, return to previous activities isn't systematic.