Phosphorylation of spinal N‐methyl‐d‐aspartate receptor NR1 subunits by extracellular signal‐regulated kinase in dorsal horn neurons and microglia contributes to diabetes‐induced painful neuropathy

The N‐methyl‐d ‐aspartate receptor (NMDAR) contributes to central sensitization in the spinal cord, a phenomenon which comprises various pathophysiological mechanisms responsible for neuropathic pain‐like signs in animal models. NMDAR function is modulated by post‐translational modifications including phosphorylation, and this is proposed to underlie its involvement in the production of pain hypersensitivity. As in diabetic patients, streptozotocin‐induced diabetic rats exhibit or not somatic mechanical hyperalgesia; these rats were named DH and DNH respectively. At three weeks of diabetes, we present evidence that somatic mechanical hyperalgesia was correlated with an enhanced phosphorylation of the NMDAR NR1 subunit (pNR1) in the rat spinal cord. This increase was not found in normal and DNH rats, suggesting that this regulation was specific to hyperalgesia. Double immunofluorescence studies revealed that the numbers of pNR1‐immunoreactive neurons and microglial cells were significantly increased in all laminae (I—II and III—VI) of the dorsal horn from DH animals. Western‐blots analysis showed no change in NR1 protein levels, whatever the behavioural and glycemic status of the animals. Chronic intrathecal treatment (5μg/rat/day for 7 days) by U0126 and MK801, which blocked MEK (an upstream kinase of extracellular signal‐regulated protein kinase: ERK) and the NMDAR respectively, simultaneously suppressed somatic mechanical hyperalgesia developed by diabetic rats and decreased pNR1. These results indicate for the first time that increased expression of pNR1 is regulated by ERK and the NMDAR via a feedforward mechanism in spinal neurons and microglia and represents one mechanism involved in central sensitization and somatic mechanical hyperalgesia after diabetes.     

Behavioural disturbance requiring medical referral: A case of anti‐N‐methyl‐D‐aspartate receptor encephalitis in the emergency department

A 17‐year‐old woman presented to the ED with behavioural disturbance and psychotic features. Brief dystonic jerks were noted so she was referred to the medical team. A diagnosis of anti‐N‐methyl‐D‐aspartate receptor encephalitis was made. Immunotherapy was instituted early and the clinical outcome was excellent. It is important to consider this condition in young women presenting with acute behavioural or psychotic symptoms.     

Intravenous methylprednisolone versus therapeutic plasma exchange for treatment of anti‐n‐methyl‐d‐aspartate receptor antibody encephalitis: A retrospective review

Introduction : Anti‐N‐methyl‐d ‐aspartate (NMDA) receptor antibody encephalitis is an increasingly recognized form of autoimmune encephalitis. Conventional treatments include therapies such as corticosteroids, intravenous immunoglobulin (IVIg), and/or therapeutic plasma exchange (TPE). Although TPE is regularly used for treatment of anti‐NMDA receptor antibody encephalitis, the American Society for Apheresis has given it a category III recommendation only. Earlier administered immunotherapies in tumor‐negative patients may facilitate faster recoveries, but it remains unclear whether or not TPE is superior to steroids and/or IVIG. Methods : We retrospectively evaluated 10 of 14 patients that received steroids and TPE with modified Rankin scores and subjectively assessed the point of largest sustained improvement in all 14 patients. Results : In the patients that received both steroids and TPE at our institution during the same hospitalization (only 10 of 14 patients), 7/10 patients after TPE had improved with the modified Rankin score versus 3/10 patients after steroids. The average modified Rankin score improvement after steroids in this group was ?0.1 as compared with 0.4 after TPE. Based on subjective chart review analysis during which all 14 patients were assessed, the largest sustained improvement occurred immediately following the third–fifth exchange in 9/14 patients, whereas only 2/14 patients appeared to have had significant benefit immediately following steroids. Conclusions : This is compelling preliminary data that suggests that corticosteroids may not be as effective compared to steroids followed by TPE. Given the importance of time‐sensitive treatment, more formal studies may illuminate the ideal first‐line treatment for anti‐NMDA receptor antibody encephalitis. J. Clin. Apheresis 30:212–216, 2015. © 2015 Wiley Periodicals, Inc.     

N-methyl-D-aspartate receptor encephalitis: laboratory diagnostics and comparative clinical features in adults and children

Introduction: N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most common autoimmune encephalitis due to autoantibodies against neuronal surface antigens, can affect both children and adults, leading to neurological and neuropsychological sequelae. However, it is potentially treatable and the prompt start of immunotherapy associates with better prognosis. Conversely, misdiagnosis can be harmful. The detection of NMDAR antibodies in serum and cerebrospinal fluid plays a pivotal role in the diagnostic work-up. Reliable methods for NMDAR antibody detection are thus fundamental to assure accurate diagnosis and allow early treatments.

Areas covered: This review recapitulates the pathogenic mechanisms of NMDAR encephalitis as a model of antibody mediated synaptopathy, and gives insights into the related state-of-the-art laboratory testing. The differences in clinical presentations, tumor associations and responses to treatments between adults and children are also described.

Expert commentary: The relevance of NMDAR encephalitis has placed neuroimmunology laboratories in a crucial position, but methods for NMDAR antibody detection are awaiting thorough and consensus-based standardizations. In the next few years, this process, along with novel insights into the pathogenic mechanisms, could improve the disease management and clarify the still pending role of NMDAR antibodies in healthy people and in other more common neuropsychiatric disorders.     

Acute psychiatric symptoms in a young woman with anti‐N‐methyl D‐aspartate receptor encephalitis: A case of successful early diagnosis and therapeutic intervention

This clinical image presents a report on the diagnosis and treatment of anti‐NMDAR encephalitis, a rare disease. This report emphasizes the importance of a differential diagnosis for acute psychiatric symptoms. Accurate and timely diagnosis is critical for the selection and implementation of treatment and for optimal patient outcomes.     

Acute non-herpetic encephalitides

"Acute non-herpetic encephalitis" was consisted of several non-herpetic encephalitides including "acute juvenile female non-herpetic encephalitis (AJFNHE)" and "non-herpetic limbic encephalitis(NHLE)". In 1997, we first reported five young adult female patients with acute non-herpetic encephalitis who presented with severe prolonged coma and status epilepticus, but achieved a good recovery. Following this report, the results of a clinical analysis on 89 serial patients with encephalitides indicated that such patients presented specific and different clinical features, including the frequent detection of anti-glutamate receptor (GluR) antibody as compared with other etiologies of encephalitis. Since all of their 11 patients were young adult women, we designated these patients as "acute juvenile female non-herpetic encephalitis (AJFNHE)". In 2007, Dalmau et al. reported anti-N-methyl-D-aspartate receptor(NMDAR) encephalitis associated with ovarian teratoma. We recently reported the results of a nationwide survey on AJFNHE in Japan. This result was indicated that AJFNHE and anti-NMDAR encephalitis were inferred to be almost identical condition. AJFNHE thus represented a clinical concept based on the specific clinical features, and anti-NMDAR encephalitis represented a clinical entity based on the neuro-oncological findings including the NMDAR NR1 and NR2 heteromer antibody.     

Adjunct therapeutic plasma exchange for anti-N-methyl-D-aspartate receptor antibody encephalitis: a case report and review of literature

Encephalitis associated with autoantibodies directed against the N-methyl-D-aspartate receptor (NMDAR) is usually a paraneoplastic syndrome that presents in young females with ovarian teratomas. We report a case of a previously healthy 14-year-old girl with sudden-onset paranoia, hallucinations, hyperactivity, increased speech, decreased sleep, seizures, and violent behavior deteriorating to catatonia. Her cerebrospinal fluid tested positive for anti-NMDAR antibodies. She was treated with five sessions of therapeutic plasma exchange (TPE) after having failed therapy with antibiotics, intravenous steroids, intravenous immunoglobulin (IVIG), one dose of rituximab, and seven sessions of electroconvulsive therapy (ECT). The American Society for Apheresis assigns a Category III (Grade 2C) recommendation for TPE in paraneoplastic neurologic syndromes; however, apheresis specifically for anti-NMDAR encephalitis has not been well studied. Literature review revealed two case reports describing outstanding improvement in patients with anti-NMDAR encephalitis following TPE. We report no improvement in our patient's symptoms after plasma exchange and discuss possible reasons for why it failed along with review of the literature.     

Therapeutic plasma exchange and immunosuppressive therapy in a patient with anti‐GAD antibody‐related epilepsy: Quantification of the antibody response

Antibodies to glutamic acid decarboxylase (GAD) have been associated with a host of neurological disorders including stiff person syndrome, cerebellar ataxia, limbic encephalitis, and epilepsy. Whether anti‐GAD antibodies have an etiological role in these neurological disorders or simply serve as disease markers is unclear. Here, we report a case of a patient with recurrent seizures, poorly responsive to conventional treatment, associated with anti‐GAD antibodies. The patient was experiencing near daily seizures at the time of presentation and had marked improvement while receiving immunosuppressive therapy and therapeutic plasma exchange (TPE). We go on to show that the patient had a substantial reduction of her GAD autoantibody burden following this therapy. Using immunostaining, we further demonstrate a progressive loss of GAD reactivity in the patient's sera to neurons and GAD‐expressing HELA cells with successive TPEs. Hence, these data support the concept of an immune‐mediated pathogenic component to these autoantibody‐associated neurological syndromes. J. Clin. Apheresis 30:8–14, 2015. © 2014 Wiley Periodicals, Inc.     

An observational study on the effect of S(+)‐ketamine on chronic pain versus experimental acute pain in Complex Regional Pain Syndrome type 1 patients

Aims The aim of the study was to explore the analgesic effect of the N‐methyl‐d ‐aspartate receptor (NMDAR) antagonist ketamine in acute experimental versus chronic spontaneous pain in Complex Regional Pain Syndrome type 1 (CRPS‐1) patients. Methods: Ten patients suffering from chronic CRPS‐1 and with a Visual Analogue pain Score (VAS) of >5 were recruited. Seven intravenous 5‐min low‐dose S(+)‐ketamine infusions with increasing doses at 20‐min intervals were applied. Spontaneous pain ratings and VAS responses to experimental heat stimuli were obtained during infusion and for 3‐h following infusion. Results: CRPS pain: Ketamine produced potent analgesia with a significant VAS reduction from 6.2 ± 0.2 to 0.4 ± 0.3 cm at the end of infusion. Analgesia persisted beyond the infusion period (VAS = 2.8 ± 1.0 cm at 5‐h), when measured plasma ketamine concentrations were low (<100 ng/ml). Experimental pain: Ketamine had a dose‐dependent antinociceptive effect on experimental pain that ended immediately upon the termination of infusion. Discussion: The data indicate that while ketamine's effect on acute experimental pain is driven by pharmacokinetics, its effect on CRPS pain persisted beyond the infusion period when drug concentrations were below the analgesia threshold for acute pain. This indicates a disease modulatory role for ketamine in CRPS‐1 pain, possibly via desensitization of NMDAR in the spinal cord or restoration of inhibitory sensory control in the brain.     

Psychosocial functioning and self‐rated health in Japanese school‐aged children: A cross‐sectional study

Emotional and behavioral disorders in children are school‐health concerns; however, Japanese screening tools for such disorders are not yet available. We examined the association between psychosocial functioning as measured by the Pediatric Symptom Checklist (PSC) and self‐rated health within school settings. A cross‐sectional study was conducted for 2513 fifth and eighth graders from all of the primary and secondary schools in Shunan City, Japan. The Japanese PSC had high internal consistency (Cronbach's α = 0.90) and a factor structure similar to that of the English PSC. When the cut‐off values were set to ≥ 28 and ≥ 17, 4–9% and 20–39% of our respondents, respectively, reported high PSC scores. A multiple ordinal logistic regression analysis showed that the odds ratio of a positive PSC score (≥ 28) for poorer self‐rated health among ratings of “very good,” “good,” “fair,” and “poor” was 3.5 (95% confidence interval = 2.6–4.8). There was a clear association between psychosocial dysfunction identified by a PSC score ≥ 28 and poor self‐rated health. We offer directions for further research on appropriate PSC cut‐off values with Japanese samples.     

Endothelium‐dependent and endothelium‐independent effects of 1‐nitro‐2‐propylbenzene on rat aorta

A group of nitro compounds contains a benzene ring in a short aliphatic chain with the NO₂ group, property that supposedly favors its vasodilator profile. In this study, we evaluated in isolated rat aorta the effects of 1‐nitro‐2‐propylbenzene (NPB), a nitro compound containing the NO₂ in the aromatic ring. In aorta precontracted with KCl, NPB (1‐3000 μm ) induced full endothelium‐independent relaxation. In endothelium‐intact preparations, phenylephrine‐induced contractions were fully relaxed by NPB, effect unaltered by N(ω)‐nitro‐L‐arginine methyl ester (L‐NAME) or 1H‐[1,2,4]oxadiazolo[4,3‐a]quinoxalin‐1‐one (ODQ). In the concentration range of 30–300 μm , NPB slightly but significantly potentiated the phenylephrine‐induced contraction. Such potentiation was unaltered by the thromboxane‐prostanoid receptor antagonist seratrodast, but was abolished by endothelium removal or by preincubation of endothelium‐intact preparations with L‐NAME, ODQ or by ruthenium red and HC‐030031, blockers of subtype 1 of ankyrin transient receptor potential (TRPA₁) channels. Verapamil exacerbated the potentiating effect of NPB. The potentiating effect was undetectable in preparations precontracted by 9,11‐dideoxy‐11α,9α‐epoxymethanoprostaglandin F2α (U‐46619). Relaxation was reduced by ruthenium red while it was enhanced by HC‐030031. In conclusion, NPB has vasodilator properties but with a mechanism of action distinct from its analogues. Contrary to other nitro compounds, its relaxing effects did not involve recruitment of the guanylyl cyclase pathway. NPB has also endothelium‐dependent potentiating properties on phenylephrine‐induced contractions, a phenomenon that putatively required a role of endothelial TRPA₁ channels. The present findings reinforce the notion that the functional group NO₂ in the aliphatic chain of these nitro compounds determines favorably their vasodilator properties.     

Acute intravenous injection and short‐term oral administration of NG‐nitro‐l‐arginine methyl ester to the rat provoke increased pressor responses to agonists and hypertension,but not inhibition of acetylcholine‐induced hypotensive responses

In experiments in vivo, we studied whether the endothelial dysfunction induced by nitric oxide (NO) synthesis inhibition is simultaneously or sequentially manifested as a reduced level of endothelium‐dependent agonist‐induced vasodilatation, an increased responsiveness to vasoconstrictors, and hypertension. Vascular responses to acetylcholine, phenylephrine, and angiotensin II were measured in pithed rats after acute intravenous injection (100 mg/kg) and short‐term oral administration of N^G‐nitro‐l ‐arginine methyl ester (l ‐NAME; 60 mg/kg per day) for 1 and 3 days (l ‐NAME_1d and l ‐NAME_3d, respectively). Pithed rats were chosen because drug‐induced cardiovascular responses reflect only peripheral effects. Parallel experiments examined mean arterial pressure (MAP) values in anesthetized rats. After short‐term l ‐NAME_1d and l ‐NAME_3d treatments, the MAP was significantly elevated in anesthetized but not pithed rats. Acute intravenous administration of l ‐NAME elevated MAP in pithed rats. Intravenous infusion of phenylephrine was used to compensate for the pressor response induced by l ‐NAME in pithed animals. The maximum decrease and duration of the hypotensive responses to acetylcholine were unaltered by the acute and both short‐term l ‐NAME treatments in pithed rats. These treatments, on the other hand, increased phenylephrine‐ and angiotensin II‐induced pressor responses in pithed animals. In isolated aortic rings prepared from pithed rats treated acutely and short‐term with l ‐NAME, acetylcholine‐induced relaxations were inhibited. Thus, the inhibition of NO‐dependent vasodilator tone after acute intravenous injection and short‐term oral l ‐NAME administration may be associated with vascular smooth muscle hyper‐responsiveness to pressor agonists and hypertension, whereas the hypotensive responses to acetylcholine could not be associated with the l ‐NAME‐induced endothelial dysfunction in pithed rats.     

抗N- 甲基-D- 天冬氨酸受体脑炎的筛查及临床分析

目的 分析不明原因脑炎患者的脑脊液及血清学相关参数,探讨抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎在不明原因脑炎中的患病比例和临床特点。方法 收集2017年1月～2018年12月就诊入院的128例不明原因脑炎的病例资料,对患者脑脊液标本进行抗NMDAR抗体、常规及生化检测,对血清标本进行抗NMDAR抗体和肿瘤标志物检测,对筛选结果及确诊为抗NMDAR脑炎患者的临床资料进行分析。结果 128例不明原因脑炎患者,脑脊液抗NMDAR抗体阳性22例(17.2%),脑脊液常规及生化分析阳性42例(32.8%),血清抗体阳性20例(15.6%),肿瘤标志物检测阳性7例(5.5%)。确诊抗NMDAR脑炎患者22例,其中血清抗NMDAR抗体检测阳性率90.9%,脑脊液抗体阳性率100%,脑脊液常规及生化分析阳性率77.3%,肿瘤标志物检测阳性率为9.1%。确诊患者临床表现多为精神行为异常和癫痫样发作; 脑电图异常多为双额、颞、中央导联为慢波。颅脑磁共振成像(MRI)多为额颞叶T2加权像及液体衰减反转恢复序列异常信号,部分显示双侧或单侧颞角扩大。结论 脑脊液抗NMDAR抗体检查是确诊抗NMDAR脑炎的金标准,不明病因脑炎患者结合临床症状进行相关检测,对抗NMDAR脑炎的早期确诊有重要意义。     

Obstructed bi‐leaflet prosthetic mitral valve imaging with real‐time three‐dimensional transesophageal echocardiography

Real‐time three‐dimensional transesophageal echocardiography (RT3D‐TEE) can provide unique visualization and better understanding of the relationship among cardiac structures. Here, we report the case of an 85‐year‐old woman with an obstructed mitral prosthetic valve diagnosed promptly by RT3D‐TEE, which clearly showed a leaflet stuck in the closed position. The opening and closing angles of the valve leaflets measured by RT3D‐TEE were compatible with those measured by fluoroscopy. Moreover, RT3D‐TEE revealed, in the ring of the prosthetic valve, thrombi that were not visible on fluoroscopy. RT3D‐TEE might be a valuable diagnostic technique for prosthetic mitral valve thrombosis. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43 :64–67, 2015     

Long‐Term Care Quality‐of‐Life Scale utility in community home care

This study aimed to test the utility of the Long‐Term Care Quality‐of‐Life assessment scale within community home care contexts and to compare the scale against the World Health Organization Quality‐of‐Life scale in terms of reliability and validity. Both scales were administered concurrently to 109 older adults receiving home care. Analysis revealed the Long‐Term Care Quality‐of‐Life scale to have good test–retest reliability, modest but acceptable internal consistency, and pairwise comparison between the Long‐Term Care Quality‐of‐Life and World Health Organization Quality‐of‐Life scales' scores suggesting moderate‐to‐strong correlation of criterion validity and comparability between scales. The results showed that the assessment of individual perceptions of life quality within home care contexts can be monitored and recorded, and that Long‐Term Care Quality‐of‐Life scale monitoring in home and residential care can identify opportunities for quality‐of‐life support and care continuity, even with transitions between care services and systems. The implications of the present study lie in having access to a validated quality‐of‐life assessment scale that can be used across care contexts to support evidence‐based practice, continuity of care, and acknowledgement of individual circumstances in services and care planning.     

Additive manufacturing of poly[(R)‐3‐hydroxybutyrate‐co‐(R)‐3‐hydroxyhexanoate] scaffolds for engineered bone development

A wide range of poly(hydroxyalkanoate)s (PHAs), a class of biodegradable polyesters produced by various bacteria grown under unbalanced conditions, have been proposed for the fabrication of tissue‐engineering scaffolds. In this study, the manufacture of poly[(R)‐3‐hydroxybutyrate‐co‐(R)‐3‐hydroxyhexanoate] (or PHBHHx) scaffolds, by means of an additive manufacturing technique based on a computer‐controlled wet‐spinning system, was investigated. By optimizing the processing parameters, three‐dimensional scaffolds with different internal architectures were fabricated, based on a layer‐by‐layer approach. The resulting scaffolds were characterized by scanning electron microscopy, which showed good control over the fibre alignment and a fully interconnected porous network, with porosity in the range 79–88%, fibre diameter 47–76 µm and pore size 123–789 µm. Moreover, the resulting fibres presented an internal porosity connected to the external fibre surface as a consequence of the phase‐inversion process governing the solidification of the polymer solution. Scaffold compressive modulus and yield stress and strain could be varied in a certain range by changing the architectural parameters. Cell‐culture experiments employing the MC3T3‐E1 murine pre‐osteoblast cell line showed good cell proliferation after 21 days of culture. The PHBHHx scaffolds demonstrated promising results in terms of cell differentiation towards an osteoblast phenotype. Copyright © 2014 John Wiley & Sons, Ltd.     

Endothelial colony‐forming cells for preparing prevascular three‐dimensional cell‐dense tissues using cell‐sheet engineering

Vascular‐derived endothelial cell (EC) network prefabrication in three‐dimensional (3D) tissue constructs before transplantation is useful for inducing functional anastomosis with the host vasculature. However, the clinical application of ECs is limited by cell isolation from the existing vasculature, because of the requirement for invasive biopsies and difficulty in obtaining a sufficient number of cells. Endothelial colony‐forming cells (ECFCs), which are a subtype of endothelial progenitor cells in the blood, have a strong proliferative and vasculogenic potential. This study attempted to fabricate prevascular 3D cell‐dense tissue constructs using cord blood‐derived ECFCs and evaluate the in vivo angiogenic potential of these constructs. Human umbilical vascular endothelial cells (HUVECs) were also used in comparison with ECFCs, which were sandwiched between two human dermal‐derived fibroblast (FB) sheets using a fibrin‐coated cell‐sheet manipulator. The inserted ECFCs in double‐layered FB sheets were cultured for 3 days, resulting in the formation of network structures similar to those of HUVECs. Additionally, when ECFCs were sandwiched with three FB sheets, a lumen structure was found in the triple‐layered cell‐sheet constructs at 3 days after co‐culture. These constructs containing ECFCs were transplanted into the subcutaneous tissue of immune‐deficient rats. One week after transplantation, ECFC‐lined functional microvessels containing rat erythrocytes were observed in the same manner as transplanted HUVEC‐positive grafts. These results suggest that ECFCs might become an alternative cell source for fabricating a prevascular structure in 3D cell‐dense tissue constructs for clinical application. Copyright © 2013 John Wiley & Sons, Ltd.     

18F‐Fluorine‐18‐l‐dihydroxyphenylalanine (18F‐DOPA) positive isolated peritoneal carcinomatosis from a MENII‐related medullary thyroid carcinoma. About an atypical metastatic site and utility of 18F‐FDOPA

A patient, operated for a medullary thyroid carcinoma (MTC) with a positive RET mutation, showed several peritoneal nodes on a computed tomography (CT), with increased Thyrocalcitonine. A ¹⁸F‐Fluorine‐18‐l ‐dihydroxyphenylalanine (18‐F‐FDOPA) positron emission tomography (PET/CT) showed isolated tracer uptake on the nodes. A biopsy confirmed that it was from the MTC, with the same RET mutation as in blood.     

Improvement of refractory pruritus after lipoprotein‐apheresis in arthrogryposis‐renal failure‐cholestasis syndrome

Accumulation of bile acids can lead to invalidating pruritus in cholestatic patients. Few reports exist on the influence of lipoprotein‐apheresis (LA) on plasma level of total bile acids (tBA). We report of significant decrease in tBA levels and drastic improvement of pruritus in a 5‐year‐old girl with arthrogryposis‐renal failure‐cholestasis syndrome. We present LA as a suitable rescue treatment option in therapy‐refractory cholestasis‐associated pruritus, at least as bridge until a long‐term solution such as entero‐biliary anastomosis or transplantation is possible.     

抗N-甲基-D-天冬氨酸受体脑炎八例分析

目的：探讨抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者的临床表现、辅助检查特点、治疗和预后。 方法：回顾性分析我院8例确诊为抗NMDAR脑炎患者的临床资料。结果：5例患者出现前驱症状;所有患者 临床症状均出现快速进展的精神行为异常、认知障碍,4例为首发症状,此外表现有言语障碍、癫痫发作、运 动障碍、意识水平下降及自主神经功能障碍等;8例患者脑脊液抗NMDAR抗体阳性,3例头MRI检查显示异 常病灶,位于大脑皮质、丘脑、海马、脑干等部位。6例患者脑电图异常,为弥漫性慢波或局灶性痫样放电。 所有患者均接受一线免疫治疗,延误诊治的1例患者对治疗反应差并出现复发。结论：抗NMDAR脑炎临床 表现复杂多样,但具有其特点,对于出现不明原因的精神行为异常或认知障碍的青年患者,及时行抗NMDAR抗体筛查十分必要,早期治疗预后良好。