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  • Title: Possible autoimmune association between herpes simplex virus infection and subsequent anti-N-methyl-d-aspartate receptor encephalitis: a pediatric patient with abnormal movements.
    Author: Yushvayev-Cavalier Y, Nichter C, Ramirez-Zamora A.
    Journal: Pediatr Neurol; 2015 Apr; 52(4):454-6. PubMed ID: 25661288.
    Abstract:
    AIM: We describe a child with severe generalized choreoathetosis and anti-N-methyl-d-aspartate receptor encephalitis after herpes simplex virus type 1 encephalitis. Recent evidence supports an autoimmune trigger for anti-N-methyl-d-aspartate receptor encephalitis following a viral infection. This is emerging as a common and potentially treatable autoimmune condition in the pediatric population. PATIENT DESCRIPTION: A 6-month-old girl presented with fever, diarrhea, and partial seizures and was subsequently treated for proven herpes simplex virus type 1 encephalitis. Shortly thereafter, she developed irritability, insomnia, dysautonomia, orolingual and facial choreodystonic movements, spontaneous vocalizations, and choreoathetoid movements of her trunk and limbs. Cerebrospinal fluid analysis confirmed anti-N-methyl-d-aspartate receptor antibodies. Management of her movements required titrated doses of clobazam, valproate, tetrabenazine, and immunotherapy. At 3 months' follow-up, her abnormal movements had completely resolved. CONCLUSIONS: Our patient adds to recent evidence linking a viral trigger for brain autoimmunity. Movement disorders appear early, leading to severe patient and family distress, and pose a serious management dilemma because of a paucity of clinical trials assessing treatments in the pediatric population. Abnormal hyperkinetic movements present early and prominently, requiring a combination of symptomatic and immune-modulating therapies for successful treatment.
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