Diagnostic Value of N-methyl-D-aspartate Receptor Antibodies in Women With New-Onset Epilepsy

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Abstract
A new type of encephalitis in female patients younger than 45 years has recently been described.1 The associated syndrome is characterized by an acute organic psychiatric disorder, seizures, dyskinesias, autonomic instability, abnormal cardiac conduction, a decreased level of consciousness, and central hypoventilation, suggesting diffuse brain dysfunction in most patients.1,2 Many patients have an ovarian teratoma, but the disorder may occur without tumor association.3,4 The target epitopes are contained in NR1/NR2 heteromers of the N-methyl-D-aspartate receptor (NMDAR).1 Despite severe and potentially lethal symptoms, most patients experience remarkable improvement after tumor removal and subsequent immunotherapy.1 This distinguishes this encephalitis from paraneoplastic encephalitides with “well-characterized” onconeural antibodies5 directed to intracellular antigens.6