Differentiating Anti-NMDA receptor encephalitis from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;AE Dheeraj Makkar, M.D.[2]

Differentiating Anti-NMDA Receptor Encephalitis from other Diseases

Antigen	NMDA receptor NR1	Lgil	CASPR2	AMPA receptor	GABA B receptor	Glycine receptor	MgluR5
Age(median)/gender female : male	0·6–85 (21) 4:1	30–80 (60) 1:2	46–77 (60) 1:4	38–87 (60) 9:1	24–75 (62) 1:1	5–69 (43) 6:5	46, 15 1:1
Clinical syndrome	1.Prodromal Syndrome 2. Psychiatric Syndrome, seizures, amnesia 3.Movement disorders catatonia, autonomic instability,	Limbic encephalitis, tonic or facio-brachial dystonic seizures, myoclonus	Morvan Syndrome, encephalitis, neuromyotonia	Limbic encephalitis, psychiatric syndrome	Limbic encephalitis	Encephalomyelitis with rigidity and myoclonus, hyperekplexia, stiff-person syndrome, (retinopathy)	Limbic encephalitis, myoclonus
MRI T2/FLAIR hyperintensities, medial temporal	25%	80%	40%	90%	70%	10%	50%
CSF pleocytosis or Oligoclonal Bands	95%	40%	25%	90%	90%	some oligoclonal bands	2/2 only cases reported and present in them

ocb: oligoclonal bands; EEG: electroencephalograph; NMDA: N-methyl-D-aspartate; AMPA: α-amino-3-hydroxy-5-methyl-4-isoxazol-propionic acid; GABA: γ-amino-butyric acid receptor; CASPR2: contactin-associated protein-like 2; Lgi1: leucine-rich, glioma-inactivated 1; mGluR5: metabotrophic glutamate receptor 5.

Other etiologies causing Anti NMDA encephalitis like features

Differential diagnosis
Bacterial and viral infections of the brain	Herpes simplex virus type 1, Human herpes virus type 6, Enterovirus, Mycoplasma
Autoimmune-associated encephalitis	PANDAS, Sydenham chorea, Hashimoto encephalopathy, Rasmussen encephalitis, Encephalitis lethargica
Autoimmune synaptic receptor encephalitides	Neuronal antibodies to GABA, AMPA, and LGI1receptors
CNS vasculitis	Primary CNS angiitis, Secondary (due to chronic infection, inflammatory processes)