Brief Communication N‐methyl‐D‐aspartate receptor antibodies in pediatric dyskinetic encephalitis lethargica** Russell C. Dale PhD Sarosh R. Irani MRCP Fabienne Brilot PhD Sekhar Pillai FRACP Richard Webster FRACP Deepak Gill FRACP Bethan Lang PhD Angela Vincent FRCPath First published: 20 July 2009 Cited by: 11 *Potential conflict of interest: A.V. and her department receive payments and royalties for antibody assays. *Pfizer had no role in study design, data collection, data analysis, data interpretation, or the writing of the manuscript. Abstract Encephalitis lethargica (EL) describes an encephalitis with psychiatric, sleep, and extrapyramidal movement disorders. Dyskinetic and Parkinsonian forms have been described. EL shares clinical features with the anti–N‐methyl‐D‐aspartate receptor (NMDAR‐Ab) encephalitis. We studied 20 sera from pediatric patients with contemporary EL. Ten sera (from 2 males and 8 females, aged 1.3–13 years) and 6/6 cerebrospinal fluid samples were positive for NMDAR‐Ab. NMDAR‐Ab–positive patients had dyskinesias, agitation, seizures, and insomnia, whereas Parkinsonism and somnolence dominated in the NMDAR‐Ab–negative children. We were unable to identify any tumors. The dyskinetic form of EL is an NMDAR‐Ab encephalitis and can affect very young children. Ann Neurol 2009;66:704–709 Citing Literature Number of times cited: 11 Elizabeth J. Slow and Anthony E. Lang, Oculogyric crises: A review of phenomenology, etiology, pathogenesis, and treatment, Movement Disorders, 32, 2, (193-202), (2017). Wiley Online Library Shannon J. Beasley and Judith M. Greer, Autoantibodies and their potential roles in diseases of the nervous system, Clinical and Experimental Neuroimmunology, 6, 4, (370-386), (2015). Wiley Online Library Frank Leypoldt, Thaís Armangue and Josep Dalmau, Autoimmune encephalopathies, Annals of the New York Academy of Sciences, 1338, 1, (94-114), (2014). Wiley Online Library Nese Sinmaz, Mazen Amatoury, Vera Merheb, Sudarshini Ramanathan, Russell C. Dale and Fabienne Brilot, Autoantibodies in movement and psychiatric disorders: updated concepts in detection methods, pathogenicity, and CNS entry, Annals of the New York Academy of Sciences, 1351, 1, (22-38), (2015). Wiley Online Library Jehan Suleiman and Russell C Dale, The recognition and treatment of autoimmune epilepsy in children, Developmental Medicine & Child Neurology, 57, 5, (431-440), (2014). Wiley Online Library Shekeeb S. Mohammad, Victor S.C. Fung, Padraic Grattan‐Smith, Deepak Gill, Sekhar Pillai, Sudarshini Ramanathan, Fabienne Brilot and Russell C. Dale, Movement disorders in children with anti‐NMDAR encephalitis and other autoimmune encephalopathies, Movement Disorders, 29, 12, (1539-1542), (2014). Wiley Online Library Sarosh R. Irani, Jeffrey M. Gelfand, Adam Al‐Diwani and Angela Vincent, Cell‐surface central nervous system autoantibodies: Clinical relevance and emerging paradigms, Annals of Neurology, 76, 2, (168-184), (2014). Wiley Online Library Jehan Suleiman, Sukhvir Wright, Deepak Gill, Fabienne Brilot, Patrick Waters, Ken Peacock, Peter Procopis, Anjan Nibber, Angela Vincent, Russell C. Dale and Bethan Lang, Autoantibodies to neuronal antigens in children with new‐onset seizures classified according to the revised ILAE organization of seizures and epilepsies, Epilepsia, 54, 12, (2091-2100), (2013). Wiley Online Library Edgar Meinl, Tobias Derfuss and Chris Linington, Identifying targets for autoantibodies in CNS inflammation: Strategies and achievements, Clinical and Experimental Neuroimmunology, 1, 2, (47-60), (2010). Wiley Online Library Michael P. Malter, Christoph Helmstaedter, Horst Urbach, Angela Vincent and Christian G. Bien, Antibodies to glutamic acid decarboxylase define a form of limbic encephalitis, Annals of Neurology, 67, 4, (470-478), (2009). Wiley Online Library Valentina Damato, Bettina Balint, Anne‐Kathrin Kienzler and Sarosh R. Irani, The clinical features, underlying immunology, and treatment of autoantibody‐mediated movement disorders, Movement Disorders, , (2018). Wiley Online Library Volume66, Issue5 November 2009 Pages 704-709
