Rehabilitation of Patient with Anti-N-methyl-D-aspartate Receptor Encephalitis with Memory Disturbance / The Japanese Journal of Rehabilitation Medicine

ABSTRACT

　Anti-N-methyl-D-aspartate（NMDA）receptor（NMDAR）encephalitis is an autoimmune disorder typically involving ovarian teratomas and a severe neuropsychiatric disorder involving prominent memory and behavioral deficits. The purpose of this study was to evaluate the clinical symptoms and outcomes of six patients（one male, five female；age：20 to 47 years）with autoantibody-associated NMDAR encephalitis, who underwent comprehensive rehabilitation in our hospital. The five female patients underwent ovarian teratoma removal. At the beginning of rehabilitation, the mean score on the Rivermead Behavioural Memory Test was 16.7, and prospective memory was preserved in two patients and was recovered in two patients. The mean Wechsler Memory Scale-Revised score of the six patients significantly increased after rehabilitation, which suggested good recovery, compared to that in the patients with herpes encephalitis. However, in the chronic state, two patients showed persistent short-term memory disturbances that required a compensatory approach and employment assistance. Four patients who were treated with convalescent cognitive rehabilitation 4.5 months after onset improved in 4 months and showed good prognoses. Three returned to work, one returned to school, and two lived independently. Patients with anti-NMDAR encephalitis respond to immunotherapy, but they exhibit persistent cognitive deficits that are related to the distribution and functional role of NMDARs in the human brain. Early intervention for the short-term memory disturbances in convalescent rehabilitation, chronic interventions for the persistent memory disturbances, and preservation of perceptive memory are important to facilitate future employment.