Anti-NMDA Receptor Encephalitis Clinical Pathway — Inpatient
Child Admitted with Suspected Anti-NMDARE
This pathway guides the evaluation, diagnosis, and treatment of children admitted with suspected anti-NMDARE in the inpatient setting.
General
anti-NMDARE is an immune-driven encephalopathy that may present in even very young children. It is associated with CSF or serum IgG antibodies to the GluN1 subunit of the NMDA receptor.
Older children and adults often present with abnormal behavior. Younger children are more likely to present with seizures or movement disorders such as facial dyskinesias and/or choreoathetosis in the setting of altered mental status.
In adults, anti-NMDARE is often associated with a tumor such as ovarian teratoma. In children, anti-NMDARE may be idiopathic, or it may be seen following HSV infection.
Criteria for Suspected anti-NMDARE
Becomes confirmed when anti-NMDA receptor antibodies are present.
- Rapid Onset, < 3 mos, of at Least 4 of the 6 Major Groups of Symptoms
- Major Symptoms
- Abnormal psychiatric behavior or cognitive dysfunction
- Speech dysfunction
- Seizures
- Movement disorder, dyskinesias, or rigidity/abnormal postures
- Decreased level of consciousness
- Autonomic dysfunction or central hypoventilation
- Major Symptoms
- At Least 1 of the Laboratory Results
- Abnormal EEG
- Focal or diffuse slow or disorganized activity, epileptic activity, or extreme delta brush
- CSF
- Pleocytosis or oligoclonal bands
- Abnormal EEG