NMDR encephalitis

Clinic

• Anti-NMDA (N-methyl-D-aspartate ) receptor encephalitis is an autoimmune encephalitis
• NMDA receptor is a protein involved incontroling thoughts, mood and movements.
• This encephalitis affects the brain more diffusely than purely the limbic system
• Typically 10 -20 days later, patients develop
  • Movement disorder: Continuous writhing and twitching of Face / Limbs
  • Autonomic manifestations (Variations in blood pressure, Heart rate and Temperature)
  • Less conscious

Sign / Symptoms

• The most distinctive starting features include prominent psychiatric symptoms, seizures, confusion and memory loss.
• Early symptoms such as fever, headache and feeling tired, is typically followed by
  • Psychosis: Delusions, Auditory / Visual Hallucinations
  • Agitation / Confusion
  • Seizures
  • Blood pressure increasing
  • Bizarre movements, mostly of the lips and mouth, but also including pedaling motions with the legs or hand movements resembling playing a piano.
  • Impaired cognition, memory deficits, and speech problems (Aphasia, Perseveration or Mutism)

Autonomic manifestations

• High fever / Thermoregulatory disorder
• Sweating
• Bladder and rectal disorders
• Large fluctuations in blood pressure and pulse
• Central apnea

Entities

• Psychosis : Delusions, Hallucinations
• Agitation
• Consciousness altered: Confusion
• Seizures
• Hypertention
• ChoreAthetosis
• Aphasia
• Cognition impaired

Miasm

JE

Suggestion

• As you see, JE miasm is highly suggested for NMDR encephalitis.
• I find a good comparative study between NMDAR and Basal Ganglion encephalitis, that suggests Stereotypies / Perseveration as a good feature for NMDAR encephalitis, whereas their absence and the presence of akinesia and tremor for BGE.
• This would be a good reason that I suggest JE as the best miasm for Stereotypies