Diagnostic Value of N-methyl-D-aspartate Receptor Antibodies in Women With New-Onset Epilepsy

Abstract

A new type of encephalitis in female patients younger than 45 years has recently been described.¹ The associated syndrome is characterized by an acute organic psychiatric disorder, seizures, dyskinesias, autonomic instability, abnormal cardiac conduction, a decreased level of consciousness, and central hypoventilation, suggesting diffuse brain dysfunction in most patients.^1,2 Many patients have an ovarian teratoma, but the disorder may occur without tumor association.^3,4 The target epitopes are contained in NR1/NR2 heteromers of the N-methyl-D-aspartate receptor (NMDAR).¹ Despite severe and potentially lethal symptoms, most patients experience remarkable improvement after tumor removal and subsequent immunotherapy.¹ This distinguishes this encephalitis from paraneoplastic encephalitides with “well-characterized” onconeural antibodies⁵ directed to intracellular antigens.⁶