In my attempt to find something even Dr.
Cohen has not heard of I started exploring this new sub-specialty of
neuroimmunology. I cam across an article
on PubMed describing the features of anti-NMDA receptor encephalitis, which
seems to be correlated to antibodies neuronal cell membrane antigens such as
VGKC, NMDAR, and AMPA receptor. This
interesting disease is typically diagnosed in psychiatric hospitals because of
the severe schizophrenic symptoms including hallucinations. With the broadening realization of
neuroimmunology researchers and physicians are realizing the implications
immunopathology can cause psychiatric symptoms.
Antibodies to these antigens are tested in
CSF serum and are usually in correlation with younger women diagnosed with
ovarian teratoma. Along with
hallucinations which is often seen in schizophrenia paranoid subtype, anti-NMDA
has co-occurring symptoms often not seen between schizophrenic subtypes such as
flat affect, catatonia, and seizures.
Based on prior knowledge with psychiatry, specialists speculate the
cause of these symptoms may be due to the inhibition of NMDAR causing a
reduction of GABA release.
The use of corticosteroids and
immunoglobulins have been used for treatment along with psychiatric
medications. This poses an interesting
questions if more psychiatric disorders are link to immunopathology as well as
could treatments come from immunological drugs?
Not to mention in this particular incidence because schizophrenia has
long been misdiagnosed is there a chance that many of those in history fall
more into a category of anti-NMDA receptor encephalitis?
The field of combining neurology, psychiatry
and immunology may prove to be more relevant than originally thought.
Lizuka, T. Unique clinical
features and pathophysiology of anti-NMDA receptor encephalitis. Rinsho Shinkeigaku. 2009.
Vol 49(11). Pg 774-778.
Waas, JA. & Storm, AH. Anti-
NMDA- receptor encephalitis; a neuropsychiatric illness requiring further study. Tijdschr Psychiatry. 2012.
Vol 54(3). Pg 279-283.
I have a few thoughts about this disease, which has gotten a disproportional amount of press in recent months following a well-publicized case of a journalist developing *among other symptoms* psychosis. (Susannah Cahalan, whose book is "Brain On Fire: My Month of Madness" is out just this month).
ReplyDeleteIn Ms. Cahalan's case, the symptoms were not just sudden psychosis in an otherwise seemingly healthy woman as the book jacket would have you believe. In fact her delusions (as Cassandra points out) were accompanied by three grand mal seizures, catatonia, high blood pressure, and a high WBC count in her spinal fluid--not subtle symptoms.
I have to say that in my opinion the reason this case is receiving so much attention is that is an alternate and reversible idiopathy to chronic, irreversible, and stigma-ridden mental illnesses such as schizophrenia. As a sister to someone who had schizophrenia, I can tell you firsthand that it is a heartbreaking diagnosis and very difficult to accept.
That aside, it is an interesting phenomenon immunologically. It is, after-all an autoimmune disease impacting the very receptors that control all brain activity: the NMDA receptor.
I currently research Type 1 diabetes (T1D) at the Barbara Davis Center for Childhood Diabetes on the Anschutz Campus. T1D is a disease that involves a range of autoantibodies, though they have not been found to be the cause of the disease's islet cell pathology.
Dr. Janet Wenzlau in our lab was awarded a small grant to adapt a radioimmunoprecipitation assay we perform regularly to detect these T1D autoantibodies for use in testing sera from cases of suspected NMDA encephalopathy. Although it involves the use of radioactivity, the assay is exquisitely sensitive to low titers and tremendously accurate. The currently used method for diagnosis is a cell-based assay in which patient's serum is incubated with rat neurons, washed, and a secondary, fluorescent-tagged (anti-human) antibody is added.
We found success in optimizing the assay but have not properly validated it. The incidence of this condition is thankfully so low that sera and CSF from confirmed cases is extremely difficult to come by. Not to hijack this post, but If you know anyone who's been diagnosed, let me know!
My sibling was diagnosed w / schizophrenia about 7 yrs ago. I remember that when they did the scan. They saw seizure activity. I believe they put him on seizure meds as well as antipsychotics. Now he is still on meds but his health isn't great. High blood pressure,spitting up and regurgitating blood etc. He's been to docs and they can't finnd a cause for concern. Do u think I should tell him to be tested for this? Or am I just holding out hope that is diagnosis was a mistake?? Please email me Lorri2582@gmail.com
DeleteOops, links. Here is her original article, from which the book stems:
ReplyDeletehttp://www.nypost.com/p/news/local/item_OseCEXxo6axZ8Uyig17QKL/0
Book review on NPR (she also did an interview on Fresh Air):
http://www.npr.org/books/titles/164341965/brain-on-fire-my-month-of-madness