Diagnostic criteria for anti-NMDA receptor encephalitis
Diagnostic criteria for anti-NMDA receptor encephalitis
Probable anti-NMDA receptor encephalitis*
All three criteria must be met:
Rapid onset (<3 months) of at least four of the six following major groups of symptoms:¶
Abnormal (psychiatric) behavior or cognitive dysfunction
Speech dysfunction
Seizures
Movement disorder, dyskinesias, or rigidity/abnormal postures
Decreased level of consciousness
Autonomic dysfunction or central hypoventilation
At least one of the following laboratory results:
Abnormal EEG (focal or diffuse slow or disorganized activity, epileptic activity, or extreme delta brush)
CSF with pleocytosis or oligoclonal bands
Reasonable exclusion of other disorders
Definite anti-NMDA receptor encephalitis*
IgG anti-GluN1 antibodiesΔ in the presence of one or more of the six major groups of symptoms, after reasonable exclusion of other disorders
NMDA: N-methyl-D-aspartate; EEG: electroencephalogram; CSF: cerebrospinal fluid; IgG: immunoglobulin G. * Patients with a history of herpes simplex virus encephalitis in the previous weeks might have relapsing immune-mediated neurologic symptoms (post-herpes simplex virus encephalitis). ¶ In the presence of a systemic teratoma, diagnosis can be made in the presence of three groups of symptoms. Δ Antibody testing should include testing of CSF. If only serum is available, confirmatory tests should be included (eg, live neurons or tissue immunohistochemistry), in addition to cell-based assay.
Reproduced from: Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 2016; 15:391. Table used with the permission of Elsevier Inc. All rights reserved.