Refractory anti-NMDAR encephalitis successfully treated with bortezomib and associated movements disorders controlled with tramadol: a case report with literature review.
Serena Marita LazzarinMarco VabanesiGiordano CecchettiRaffaella FazioGiovanna Franca FanelliMaria Antonietta VolontéAngela GenchiAntonino GiordanoVittorio MartinelliSergio ColomboPaolo BeccariaMilena MucciJacopo PeccatoriMassimo FilippiFabio MinicucciPublished in: Journal of neurology (2020)
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a potentially fatal autoimmune disease, characterized by autoantibody-mediated neurotransmission impairment in multiple brain locations. The course of this condition often comprises altered mental status, autonomic dysfunctions, refractory seizures and hyperkinetic movement disorders. Available disease-modifying therapies include corticosteroids, i.v. immunoglobulins, plasma exchange, rituximab and cyclophosphamide. In a subgroup of patients not responding to B-cell depletion, bortezomib, a proteasome inhibitor, has shown promising evidence of efficacy. The time course of recovery from acute phase may be very slow (weeks/months), and only few data are available in literature about the concurrent management of encephalitis-associated movement disorders. We report a case of severe anti-NMDAR encephalitis in a 29-year-old woman, not responsive to first- and second-line treatments, with persistent involuntary motor manifestations. Starting three months after symptom onset, four cycles of bortezomib have been administered; subsequently we observed a progressive improvement of neurological status. Meanwhile, motor manifestations were controlled after the administration of tramadol, a non-competitive NMDA receptor antagonist.
Keyphrases
- newly diagnosed
- multiple myeloma
- end stage renal disease
- multiple sclerosis
- low dose
- ejection fraction
- chronic kidney disease
- systematic review
- case report
- early onset
- peritoneal dialysis
- heart rate
- mental health
- cerebral ischemia
- heart rate variability
- resting state
- squamous cell carcinoma
- electronic health record
- drug delivery
- drug induced
- brain injury
- functional connectivity
- hodgkin lymphoma
- phase iii
- locally advanced
- preterm birth
- postoperative pain
- open label
- data analysis
- double blind