N-Methyl-D-Aspartate Receptor Antibodies in Post-Herpes Simplex Virus Encephalitis Neurological Relapse

Yael Hacohen, Kumaran Deiva, Phillipa Pettingill, Patrick Waters, Ata Siddiqui, Pascale Chretien, Esse Mason, Jean-Pierre Lin, Marc Tardieu, Angela Vincent, Ming Lim

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    182 Citations (Scopus)


    Herpes simplex virus encephalitis (HSVE) is a devastating condition that relapses, often with a chorea in children, despite adequate antiviral treatment. At relapse, evidence of viral replication is frequently absent, suggesting that the relapse may be immune-mediated. Seven children who had a neurological relapse following their initial encephalitis, identified from 20 cases of pediatric HSVE, were studied. Serum and/or cerebrospinal fluid (CSF) were tested for N-methyl-D-aspartate receptor (NMDAR) and other antibodies previously reported in central nervous system autoimmunity. Five of the 7 relapsing children had choreoathetosis; 2 of these were NMDAR antibody-positive, 2 were negative (1 with HSV-positive CSF), and 1 was not available for testing. An additional patient, who relapsed with cognitive regression but with no movement disorder, was also NMDAR antibody-positive. In 2 of the NMDAR antibody-positive patients who were treated at relapse and in 1 who was treated only after 10 years of having a relapsing encephalopathy, a beneficial response was observed. Neurological relapses after HSVE may frequently be immune-mediated, particularly in children with chorea. NMDAR antibodies are common, and immunotherapy may be beneficial. 

    Original languageEnglish
    Pages (from-to)90-96
    Number of pages7
    JournalMovement Disorders
    Issue number1
    Publication statusPublished - Jan 2014


    • herpes simplex virus
    • encephalitis
    • N-methyl-D-aspartate (NMDA) receptor
    • choreoathetosis
    • movement disorder
    • relapsing


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