Anti-N-methyl-d-aspartate receptor encephalitis: A challenge to diagnose in children.

Dear Sir,

Anti-N-methyl-d-aspartate (NMDA) receptor antibody encephalitis is an interesting topic in pediatric neurology. A case report has shown teenager with intractable seizure has been diagnosed to have this disease.[1] Through this letter, we tried to focus on some recently available information about this disease. In children, it can present with subtle findings as well as frank seizure or psychosis. The presentation can be variable according to the age of the patient. Often it is tough to diagnose such entity in very young patients. Seizure and seizure mimics can be the manifestation in infants.[2] There has been a retrospective case series of children of <12 years of age. Here, it has been shown that patients may present with behavioral changes, psychosis, seizures, and oro-lingual-facial dyskinesia. Extreme irritability, insomnia as well as mutism were noticed in them.[3] Recently, hyperkinetic movement disorder in a young girl has been reported.[4] There are some characteristics of anti-NMDA encephalitis in children. The problem in speech, seizures, behavioral issues and abnormal movements are more prevalent in the pediatric population.[1] Hence, the clinical suspicion is crucial. This disease can easily be missed. It can be misdiagnosed as psychiatric disorder or encephalitis due to other causes. Early diagnosis and treatment can prevent deterioration of the affected child. In the study mentioned above intravenous methylprednisolone and immunoglobulins was the first-line therapy. This was successful in one patient out of six. Rituximab and cyclophosphamide were second-line drugs. Three out of the rest five responded to this treatment.[3] Plasma exchange may be another option.[2] No doubt more data are required to conclude about the therapeutic efficacy of these treatments. We are hopeful that more information about this disease pattern and long-term sequelae of the disease will come up and enlighten our knowledge.

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