Encefalite causada por anticorpos contra o receptor nmda. Relatório de caso e revisão da literatura
Resumo
A encefalite causada por anticorpos contra o receptor nmda é um distúrbio grave, tratável e potencialmente reversível, caracterizado pela presença de alterações comportamentais, convulsões e transtornos de movimento. A presença de anticorpos contra o receptor de glutamato (anti-nmda) no plasma ou no líquido cefalorraquidiano é específica para o diagnóstico da doença. O reconhecimento precoce da doença é vital para o prognóstico do paciente, visto que o tratamento precoce facilita a recuperação e a redução da morbimortalidade. O tratamento consiste no uso de corticoides, imunoglobulina intravenosa ou plasmaférese como primeira linha de terapia. Além de outros imunomoduladores, como ciclofosfamida ou rituximabe, como segunda linha. A recuperação é lenta, mas apresenta melhora à medida que os títulos de anticorpos diminuem e a recuperação completa ocorre em até 75% dos pacientes.
Downloads
Referências
Vitaliani R, Mason W, Ances B, Zwerdling T, Jian Z, Dalmau J. Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol. 2005; 58(4):594-604.
https://doi.org/10.1002/ana.20614
PMid:16178029 PMCid:PMC2245881
Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Dessain SK et al. Anti-NMDA-receptor encephalitis: Case series and analysis of the effects of antibodies. Lancet Neurol. 2008; 7(12):1091-8.
https://doi.org/10.1016/S1474-4422(08)70224-2
Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol. 2009; 66(1):11-8.
https://doi.org/10.1002/ana.21756
PMid:19670433 PMCid:PMC2826225
Dalmau J, Lancaster E, Martínez-Hernández E, Rosenfeld M. Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011; 10(1):63-74.
https://doi.org/10.1016/S1474-4422(10)70253-2
Armangue T. Petit-Pedrol, Mar. Dalmau J. Autoimmune encephalitis in children. J Child Neurol. 2012; 27(11):1460-9.
https://doi.org/10.1177/0883073812448838
PMid:22935553 PMCid:PMC3705178
Glaser C, Iizuka T, Honig LS, Aguilar E, Gresa N, Ryan N et al. Treatment and prognostic factors for long-term outcome in patients with anti-N-Methyl-D-Aspartate (NMDA) receptor encephalitis: a cohort study. Lancet Neurol. 2014; 12(2):157-65.
https://doi.org/10.1016/S1474-4422(12)70310-1
Warren N, Grote V, Gorman CO, Siskind D. Electroconvulsive therapy for anti-N-methyl-D-aspartate (NMDA) receptor encephalitis: A systematic review of cases. Brain Stimul. 2018; 12(2):329-34. Doi: https:// doi.org/10.1016/j.brs.2018.11.016
https://doi.org/10.1016/j.brs.2018.11.016
PMid:30528383
Khundakji Y, Masri A, Khuri N. Anti-NMDA receptor encephalitis in a toddler: A diagnostic challenge. Int J Pediatr Adolesc Med. 2018; 5(2):75-7. Doi: https://doi. org/10.1016/j.ijpam.2018.03.001
https://doi.org/10.1016/j.ijpam.2018.03.001
PMid:30805537 PMCid:PMC6363247
Guasp M, Dalmau J. Encefalitis por anticuerpos contra el receptor de NMDA. Med Clin (Barc). 2018; 151(2):71- 9. Doi: https://doi.org/10.1016/j.medcli.2017.10.015
https://doi.org/10.1016/j.medcli.2017.10.015
PMid:29183618
Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D et al. Causes of encephalitis and differences in their clinical presentations in England: A multicentre, population-based prospective study. Lancet Infect Dis. 2010; 10(12):835-44. Doi: http://dx.doi.org/10.1016/S1473-3099(10)70222-X
https://doi.org/10.1016/S1473-3099(10)70222-X
Gable MS, Sheriff H, Dalmau J, Tilley DH, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis. 2012; 54:899-904.
https://doi.org/10.1093/cid/cir1038
PMid:22281844 PMCid:PMC3297648
Florance-Ryan N, Dalmau J. Update on anti-N-methyl-D-aspartate receptor encephalitis in children and adolescents. Curr Opin Pediatr. 2010; 22:739-44.
https://doi.org/10.1097/MOP.0b013e3283402d2f
PMid:21045695
Wandinger K, Saschenbrecker S, Stoecker W, Dalmau J. Anti-NMDA-receptor encephalitis: A severe, multistage, treatable disorder presenting with psychosis. J Neuroimmunol. 2011; 231(1-2):86-91. Doi: http://dx.doi.org/10.1016/j.jneuroim.2010.09.012
https://doi.org/10.1016/j.jneuroim.2010.09.012
PMid:20951441
Miya K, Takahashi Y, Mori H. Anti-NMDAR autoimmune encephalitis. Brain Dev. 2014; 36(8):645-52. Doi: http://dx.doi.org/10.1016/j.braindev.2013.10.005
https://doi.org/10.1016/j.braindev.2013.10.005
PMid:24211006
Jones KC, Benseler SM. Anti-NMDA receptor encephalitis. Neuroimaging Clin N Am. 2013; 23(2):309-20. Doi: http://dx.doi.org/10.1016/j.nic.2012.12.009
https://doi.org/10.1016/j.nic.2012.12.009
PMid:23608692
Consoli A, Ronen K, An-gourfinkel I, Barbeau M, Marra D, Costedoat N et al. Malignant catatonia due to anti-NMDA-receptor encephalitis in a 17-year-old girl: Case report. Child Adolescent Psychiatry Ment Heal. 2011; 5(15):2-7.
https://doi.org/10.1186/1753-2000-5-15
PMid:21569502 PMCid:PMC3121673
Kurian M, Lalive P, Dalmau J, Horvath J. Opsoclonus-myoclonus syndrome in anti-N-methyl-D-aspartate receptor encephalitis. Arch Neurol. 2010; 67(1):1-5.
https://doi.org/10.1001/archneurol.2009.299
PMid:20065141 PMCid:PMC2819405
Agundez M, Mendibe M, Carlos J, Ciordia R, Saiz A, Zarranz JJ. Abnormal multifocal cerebral blood flow on Tc-99m HMPAO SPECT in a patient with anti-NMDA-receptor encephalitis. J Neurol. 2010; 257:1568-9.
https://doi.org/10.1007/s00415-010-5546-z
PMid:20352245
Peery HE, Day GS, Dunn S, Fritzler MJ, Prüss H, Souza C et al. Autoimmunity reviews anti-NMDA receptor encephalitis. The disorder, the diagnosis and the immunobiology. Autoimmun Rev. 2012;11(12):863-72. Doi: http://dx.doi.org/10.1016/j.autrev.2012.03.001
https://doi.org/10.1016/j.autrev.2012.03.001
PMid:22440397
Wong-Kisiel LC, Ji T, Renaud DL, Kotagal S, Patterson MC, Dalmau J et al. Response to immunotherapy in a 20-month-old boy with anti-NMDA receptor encephalitis. Neurology. 2010; 74:1550-1.
https://doi.org/10.1212/WNL.0b013e3181dd41a1
PMid:20458074 PMCid:PMC2875922
