Recognition and treatment of anti-n-methyl-d-aspartate receptor encephalitis

Anti-N-methyl-d-aspartate receptor encephalitis should be considered for pediatric patients who present with seizures, dysautonomia, dyskinesias, and psychiatric disturbances. Life-threatening complications from this disorder, including seizures, hypoventilation, bradycardia, and ictal asystole, should be anticipated, and the patient should be closely monitored and supported. Morbidity and mortality can be mitigated with early detection and initiation of immunotherapy and resection of a teratoma, if found. In young patients treated soon after symptom onset, the prognosis is favorable with most patients having no or mild residual neurologic deficit. Early recognition of the protean signs of this disorder in the emergency department is essential to help establish immunomodulation therapy in a timely fashion.