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Encefalitis por anticuerpos contra el receptor de NMDA: experiencia con seis pacientes pediátricos. Potencial eficacia del metotrexato

A. Bravo-Oro, C. Abud-Mendoza, A. Quezada-Corona, J. Dalmau, V. Campos-Guevara [REV NEUROL 2013;57:405-410] PMID: 24150952 DOI: https://doi.org/10.33588/rn.5709.2013180

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Volumen 57 | Number 09 | Nº of views of the article 5.499 | Nº of PDF downloads 668 | Article publication date 01/11/2013

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ABSTRACT

INTRODUCTION Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a condition that is increasingly more frequently diagnosed in the paediatric age. Unlike adults, in many cases it is not associated to tumours and the most common initial manifestations in children are seizures and movement disorders, while in adults there is a predominance of psychiatric alterations. CASE REPORTS. We present six confirmed paediatric cases with antibodies against the subunit NR1 of the NMDA receptor in serum and cerebrospinal fluid. Five of the cases began with seizures as the initial clinical symptom prior to the development of the classical clinical features of this condition. In all cases, steroids were used as the first line of treatment, although these only brought about control over the manifestations in one of them; the other patients therefore required second-line immunomodulators. All the patients received methotrexate as immunomodulator treatment to prevent relapses, and in all cases there was an improvement in the patients’ situation.

CONCLUSIONS In our series of patients with anti-NMDA receptor encephalitis, none were associated with tumours. All of them were given methotrexate for at least one year and no adverse clinical or analytical events were observed; likewise, there were no neurological sequelae or relapses during treatment. Although it is a small series and it would be advisable to increase the number and time to progression, we see methotrexate as an excellent alternative immunomodulator treatment for this pathology. KeywordsAnti-NMDA antibodies Encephalitis Immunomodulation Methotrexate Paraneoplastic syndrome Seizures

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Nota Clínica

Encefalitis por anticuerpos contra el receptor de NMDA: experiencia con seis pacientes pediátricos. Potencial eficacia del metotrexato

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