Abstract Details

Title Co-existence of Multiple Sclerosis and Anti-NMDA Receptor Encephalitis: What We Can Learn From It?

Topic Multiple Sclerosis

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-091

Objective Anti-NMDAR encephalitis is a severe autoimmune disorder that occurs in association with IgG antibodies against the GluN1 subunit of the NMDAR. An overlap between anti-NMDAR encephalitis and inflammatory demyelinating disorders, mostly Neuromyelitis Optica Spectrum Disorders had been reported, but such an association with Multiple Sclerosis is limited to only a few cases.

Background A 26-year-old female patient with a diagnosis of RRMS of 10 years previously was treated with sc interferon-beta1a, fingolimod and natalizumab; was on teriflunamide for 15 months. On her last follow-up, she was both clinically and by cranial-servical MRI to be stable with an EDSS of 1.0 on April 2018. A month later; she developed confusion, agitation, hallucinations and dysautonomia. The only change on her MRI was a single enhancing cortico-juxtacortical lesion. Cerebrospinal fluid study disclosed elevated protein and pleocytosis. On the 6th day, she was admitted to our intensive care unit with status epilepticus. She was suspected for developing anti-NMDAR encephalitis, which was confirmed by positive serology. An extensive workup of malignancy was negative. Cranial PET-MRI revealed questionable frontal hypermetabolism and significant temporoparietooccipital hypometabolism. She was treated with plasma exchange. After that, she was given 0.4 gr/ kg/5 days intravenous immunoglobuline treatment followed by 1000 mg intravenous metilprednisolone for 10 days. Then she was treated with rituximab. The patient was discharged in the second month of hospitalization with significant improvement in her clinical status except limited memory problems.

Design/Methods NA

Results NA

Conclusions In this report, our aim is to discuss the possible treatment approaches in an MS patient who has developed NMDAR encephalitis and to highlight the possible link between NMDAR encephalitis and inflammatory demyelinating disorders overlap syndromes. It is questionable whether previous use of multiple immunosuppressive therapies contributed for developing NMDAR encephalitis in an MS patient.

Authors/Disclosures
Bade Gulec PRESENTER	Bade Gulec has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Erdem Tuzun	Erdem Tuzun has nothing to disclose.
Melih Tutuncu, MD (ISTANBUL UNIVERSITESI CERRAHPASA TIP FAKULTESI)	Dr. Tutuncu has nothing to disclose.
Ugur Uygunoglu (Cerrahpasa)	Ugur Uygunoglu has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Turkey . The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen Idec/Gen Pharma of Turkey. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck-Serono of Turkey. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanovel of Turkey. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Genveon of Turkey.
	No disclosure on file
Sabahattin Saip	Sabahattin Saip has nothing to disclose.
Aksel Siva, MD (Istanbul University Cerrahpasa School of Medicine)	Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ali Raif Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanovel Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abdi Ibrahim Ilac - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono . The institution of Dr. Siva has received research support from Turkish MS Society. The institution of Dr. Siva has received research support from The Scientific and Technological Research Council Of Turkey - Health Sciences Research Grants.

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