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Observations placeholder

Two boys with encephalitis and anorexia

Identifier

012799

Type of Spiritual Experience

Hallucination

Number of hallucinations: 2

Background

They didn't find the true cause.  Saying it was NMDA mediated encephalitis is totally meaningless, it had a cause - it could have been parasites for example - the researchers should have investigated all the various animals the boys had come into contact with.  Still the observation is moderately useful as a pointer to the effect this unknown cause had on the two lads.

Thymus hyperplasia (or thymic hyperplasia) refers to an enlargement ("hyperplasia") of the thymus.  It is not always a disease state. The size of the thymus usually peaks during adolescence, and atrophies in the following decades. "Before the immune function of the thymus was well understood, the enlargement was sometimes seen as a cause for alarm, and justification for surgical reduction". It can be associated with myasthenia gravis

A description of the experience

Pediatr Neurol. 2011 Dec;45(6):412-6. doi: 10.1016/j.pediatrneurol.2011.09.012.

Two patients with an anti-N-methyl-D-aspartate receptor antibody syndrome-like presentation and negative results of testing for autoantibodies.

Shah R1, Veerapandiyan A, Winchester S, Gallentine W, Mikati MA.  1Division of Pediatric Neurology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA.

Abstract

We describe two boys whose distinct and remarkable clinical pictures suggested the possibility of anti-N-methyl-d-aspartate receptor antibody encephalitis. Both patients responded to immunotherapy, but neither manifested that antibody.

Patient 1 exhibited florid encephalopathy with psychotic manifestations including inappropriate affect, intermittent delirium, visual hallucinations, severe anorexia, agitation, paranoid ideation, and abnormal electroencephalogram results. He responded to intravenous immunoglobulin, with steady improvement over 3 months to almost complete remission for 1 year, followed by a relapse that again responded, more quickly, to intravenous immunoglobulin. A second relapse occurred 1 month later, and again responded to intravenous immunoglobulin.

Patient 2 exhibited progressive, severely debilitating limb dystonia that worsened over 1.5 years, with milder psychiatric symptoms including mood instability, aggressiveness, impulsivity, and depression. When he developed thymic hyperplasia 1.5 years into his illness, he underwent a thymectomy, and improved significantly on a regimen of plasmapheresis and intravenous immunoglobulin. Patients presenting with symptoms suggestive of autoimmune encephalitis, but without antibodies, may still respond to immunotherapy.

Copyright © 2011 Elsevier Inc. All rights reserved.

PMID:  22115008

The source of the experience

PubMed

Concepts, symbols and science items

Concepts

Symbols

Science Items

Activities and commonsteps

Commonsteps

References