Anti-NMDAR Encephalitis - Causes, Symptoms, and Treatment

Introduction

Encephalitis is inflammation of the brain. It has multiple causes, including viral infections, autoimmune inflammation, bacterial infections, and insect bites. The immune system's abnormally low or excessive activity is a result of immune system disorders. Autoimmune diseases are conditions wherein the immune system is overactive and attacks and damages the body's own tissues. The body becomes more susceptible to infections as a result of immune deficiency diseases that reduce the body's capacity to fight off invaders. An unidentified trigger may cause the immune system to start producing antibodies that target the body's own tissues rather than fighting infections. Reduced immune system activity is a common goal of treatment for autoimmune diseases.

What Is Anti-NMDAR Encephalitis?

Anti-NMDAR encephalitis occurs when antibodies (proteins of the immune system) attack proteins N-methyl-D-aspartate receptor (NMDAR) in the brain. It is referred to as autoimmune encephalitis. NMDAR aids in the regulation of thoughts, mood, and movement. Antibodies against NMDAR receptors are likely to alter these functions. This type of encephalitis affects more areas of the brain than just the limbic system, so it is typically not categorized as limbic encephalitis.

What Are the Causes of Anti-NMDAR Encephalitis?

Autoimmune disorders have no known precise cause. According to one theory, certain drugs or microorganisms (like bacteria or viruses) may cause changes that cause the immune system to become confused. People with genes that make them more susceptible to autoimmune disorders may experience this more frequently. Immunoglobulin antibody IgG, especially IgG1 and G3, form and attach to the NMDA receptor (NR1) subunit, which leads to the development of this autoimmune encephalitis.

What Are the Risk Factors for Anti-NMDAR Encephalitis?

The exact cause of anti-NMDAR encephalitis is unknown. However, there are risk factors that increase the likelihood of developing an autoimmune disease. Risk factors include:

• Drugs - Blood pressure medications, statins, and antibiotics can increase the risk of anti-NMDAR encephalitis.

• Genetics - Some autoimmune diseases are hereditary and run within families.

• Smoking - Smoking increases the risk of getting an autoimmune condition.

• Existing Autoimmune Condition - Increased risk of developing another disease.

• Exposure to Toxins - Exposures to toxins can increase the risk of developing autoimmune conditions.

• Female Sex – 78 percent of people with autoimmune diseases are females.

• Obesity - Excessive weight can increase the risk of an autoimmune condition.

• Infection - Any infection with a virus or bacteria can initiate an auto-immune condition.

What Are the Symptoms of Anti-NMDAR Encephalitis?

Early symptoms include fever, headache, and fatigue. This is usually followed by false beliefs (delusions) and psychosis (hallucinations) associated with seeing and hearing things that others do not see or hear. They are also often agitated and confused. Over time, seizures, reduced breathing rate, and fluctuations in blood pressure and heart rate usually occur. This condition is often recognized clinically in later psychotic stages, wherein delusions, hallucinations, paranoia, and agitation may be exhibited. At this stage, anti-NMDAR encephalitis is often misdiagnosed as primary psychosis or substance-induced disorder.

When to Get Help for Anti-NMDAR Encephalitis?

Seek immediate medical help in case of the following signs:

• Fever.

• Headache.

• Joint pains.

• Weakness.

• Nausea.

• Behavior changes.

• Confusion.

• Difficulty speaking or moving.

• Loss of consciousness.

• Loss of memory.

• Seizures.

• Sensitivity to light.

How Is Anti-NMDAR Encephalitis Diagnosed?

Doctors may perform many procedures to diagnose NMDAR encephalitis. Listed below are some of the procedures:

• A physical examination is done to learn more about the symptoms.

• Neurological testing to assess the brain function.

• Laboratory and imaging tests to help confirm or rule out encephalitis.

• For a spinal tap (lumbar puncture), a sample of spinal fluid is taken and tested in a laboratory.

• Blood tests assess organ functioning and check for specific types of bacteria.

• Imaging studies, such as a CT (computed tomography) scan, MRI (magnetic resonance imaging), and MEG (magnetoencephalography) test help in identifying the signs of tissue damage. They can also detect issues like tumors and brain bleeding.

What Is the Treatment of Anti-NMDAR Encephalitis?

The type of brain inflammation treatment needed depends on the type of encephalitis and its severity. The treatment of anti-NMDAR encephalitis is listed below

• An antibiotic used to treat bacterial infections.

• Antiviral drug for viral infections.

• Antiepileptic drugs, in case of seizures.

• Respiratory assistance, including supplemental oxygen or mechanical ventilation.

• Immunomodulators are drugs that suppress attacks by the immune system.

• Intravenous (IV) fluids for hydration.

• A steroid that reduces swelling and intracranial pressure.

• Giving food while unconscious by tube feeding.

What Are the Complications of Anti-NMDAR Encephalitis?

The complications of anti-NMDAR encephalitis are listed below:

• Speech and language problems.

• Swallowing problems.

• Repeated seizures or fits, otherwise known as epilepsy.

• Emotional and psychological problems, such as anxiety, depression, and mood swings.

How to Manage and Prevent Anti-NMDAR Encephalitis?

Quality of life can be improved by the following measures:

• Nutrition - What an individual eats can affect their mood. Try to eat foods rich in vitamins and nutrients. The diet should include fruits, grains, lean meats, vegetables, and dairy products.

• Working for Short Periods of Time - Only short periods of activity may be acceptable. Schedule tasks on the calendar with breaks before and after. This approach helps avoid doing too many things at once.

• Sleep - It's natural to feel tired when resting. However, persistent cognitive symptoms can also affect sleep quality. Maintaining a consistent sleep schedule and relaxing before bed can help.

• Exercise - Daily physical activity helps improve blood circulation in the body and prevent several illnesses.

• Limiting Processed Foods From Diet - Reducing the amount of processed and packaged foods from the diet leads to reduced inflammation in the body.

• Avoid Smoking - Smoking is harmful to health and exacerbates autoimmune conditions.

• Stay Away from Toxins - Staying away from toxic chemicals in paints, pesticides, and other environmental toxins can help in preventing autoimmune conditions.

Conclusion

Anti-NMDAR encephalitis is a brain inflammation that should be treated in a hospital. It precipitates when the immune system attacks brain cells, causing inflammation in the brain. Signs and symptoms of anti-NMDAR encephalitis include fever, headache, and tiredness. Symptoms that affect brain function may persist even after the infection has cleared. It takes time to reach full recovery potential. Sometimes months or years. Rehabilitation and proper self-care can maximize performance and quality of life. Treatments for autoimmune and viral encephalitis work within a few days. However, it may take time for the brain to recover. Some people experience permanent cognitive effects that require rehabilitation therapy and lifestyle changes.