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The proceedings contain 14 papers. The topics discussed include: MOG-positive anti-NMDA receptor encephalitis with no demyelinating lesions: two case reports;safety and tolerability of rozanolixizumab in the randomized phase 3 MycarinG study;Outcomes from RAISE: A randomized, phase 3 trial of zilucoplan in generalized myasthenia gravis;efficacy and safety of zilucoplan in myasthenia gravis: responder analysis from the randomized Phase 3 RAISE trial;distinct effects among calcium-binding proteins for microglia to produce chemokines associated with the clinical severity of ALS;astroglial connexin 43 is a novel therapeutic target for a chronic multiple sclerosis model;targeting lymphocytes in SPMS: Th cell populations as a biomarker to predict the efficacy of Siponimod;CSF lysophospholipids as a novel biomarker in relapsing-remitting multiple sclerosis;the immune response to SARS-COV-2 MRNA vaccines in siponimod-treated patients with secondary progressive multiple sclerosis;patient characteristics of siponimod-treated SPMS patients in Japan: interim results from post-marketing surveillance;and efficacy of ravulizumab across sex and age subgroups of patients with generalized myasthenia gravis: a post hoc analysis of the CHAMPION MG study.
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Encephalitis is the inflammation of the brain which is usually caused by viral infections, but it can be also due to other non-infectious agents. We report an interesting case of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis with Haemophilus influenzae co-infection in association with severe acute respiratory syndrome coronavirus 2, without pulmonary involvement or fever. [ FROM AUTHOR]
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BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to be a global issue. While immunizations comprise an important line of defense, adverse effects may occur. We report two cases of autoimmune conditions affecting the nervous system, anti-N-Methyl-D-Aspartate-receptor (NMDAR) encephalitis and myasthenia gravis (MG), that developed in close association with COVID-19 vaccination. CASE REPORT: In our first case, a 29-year-old woman presents with recurrent seizures, auditory hallucinations, psychiatric symptoms, and autonomic abnormalities, with an onset of 1 day after receiving the second dose of inactivated SARS-CoV-2 whole virus vaccine. CSF analysis and electroencephalogram (EEG) were consistent with anti-NMDAR encephalitis. In our second case, a 23-year-old woman presents with ocular ptosis, diplopia, hoarseness, and fatigability, which first appeared 1-day after her first dose of inactivated SARS-CoV-2 whole virus vaccine. Electromyography (EMG) results established a definite diagnosis of MG. CONCLUSION(S): To the best of our knowledge, this is the first report of anti-NMDAR encephalitis and MG associated with inactivated SARS-CoV-2 whole virus vaccine. In both cases, COVID-19 vaccination appears to be the only remarkable feature of history. The authors postulate that COVID-19 vaccination may trigger underlying defects or induce failure of positive and negative selection, which may lead to autoreactivity and subsequent autoimmunity. However, further studies are required to confirm this possibility. Copyright © 2022, Scientific Foundation SPIROSKI. All rights reserved.
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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a clinical condition characterized by a myriad of psychiatric symptoms, abnormal movements, autonomic instability, seizures, and encephalopathy. Coronavirus disease-19 (COVID-19) infection is infrequently present with altered mental status. As the days of the COVID-19 pandemic pass, more and more awareness of its different types of immunological reactions are unveiled. A wide spectrum of clinical, pathological, and radiological manifestations has been reported. However, there have only been a few cases where anti-NMDAR antibodies have been found in people who have COVID-19. Herein, we reported two cases with simultaneous anti-NMDAR antibody and COVID-19 infection detection. Both cases clinically responded after treatment with an immunomodulator, showing significant improvement, and were discharged in a conscious and ambulatory state. Autoimmune encephalitis should be thought about if there are neurological symptoms associated with SARS-CoV-2 infection, and immunomodulators should be given to such patients. [ FROM AUTHOR] Copyright of Asian Journal of Medical Sciences is the property of Manipal Colleges of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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During the outbreak of coronavirus disease 2019 (COVID-19) clinicians are increasingly involved in the observation of possible neurological complications due to the infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Some cases of encephalitis following COVID-19 pandemic have been reported in literature that can mean possible damage to the central nervous system related to the SARS-CoV-2 infection. Early on, this was thought to be due to the direct effects of the virus itself, but the possibility of immune system mechanisms being implicated was gradually raised in scientific literature. The reports of anti-NMDA receptor encephalitis among patients with COVID-19 at different ages may be signs of this condition. We report the case of 16-year teenager with concomitant Anti-N-Methyl-D-Aspartate Receptor (Anti-NMDAR) encephalitis and COVID-19. This clinical case brings arguments on the possible relationship between SARS-CoV-2 infection and autoimmune encephalitis.
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Introduction: Anti-NMDAR encephalitis is an autoimmune neurological disease characterized by the presence in the cerebrospinal fluid (CSF) of antibodies targeting the GluN1 subunit of the N-methyl D-aspartate receptors (NMDAR) in the brain. This study assessed the putative link between anti-NMDAR encephalitis and COVID-19 vaccination. Material and methods: All Individual Case Safety Reports (ICSRs) of anti-NMDAR encephalitis with Tozinameran (Comirnaty®) vaccine and registered in the World Health Organization global database (VigiBase®) up to December 31, 2021, were analyzed. A description and a disproportionality analysis were conducted, using the MedDRA reaction term "Anti-NMDA receptor encephalitis". The reported odds ratio (ROR) and its 95% 2-sided confidence interval have been calculated to compare the proportion of anti-NMDAR encephalitis reports with the suspected vaccine and the proportion of reports of the same adverse drug reaction with all other suspected drugs in the database during the same period. Results: Among the 662 168 ICSRs associated with the suspected vaccine, 3 were anti-NMDAR encephalitis. One of the patients was male (15 years old) and two were female (26 and 69 years old). All cases were serious and required hospitalization. One of those three patients died. The time to onset of anti-NMDAR encephalitis after vaccination was variable and differed between patients (from 2 to 98 days). ROR was significant [2, 95% CI (1.2;2.8)]. Discussion/Conclusion: Several cases of anti-NMDAR encephalitis have been described in the literature after vaccination. This study found a signal between the occurrence of anti-NMDAR encephalitis and Tozinameran. There are currently no available data regarding the potential implication of the vaccines against COVID-19 in the onset of autoimmune encephalitis. The exhaustive recording of anti-NMDAR encephalitis occurring after vaccines is necessary.
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The coronavirus disease 2019 (COVID-19) pandemic has had an enormous impact on the world, affecting people's lifestyle, economy, and livelihood. Recently, with the development of vaccines, the number of infected cases has decreased. Many case reports have revealed that COVID-19 may induce other serious comorbidities such as anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis. Anti-NMDA receptor encephalitis is an acute autoimmune disease that occurs more commonly in women than in men. To explore the association between COVID-19 and anti-NMDA receptor encephalitis, the microRNA (miRNA) biomarkers of COVID-19, anti-NMDA receptor encephalitis, and other related diseases from the literature are reviewed; then on the basis of these miRNA biomarkers, the relationship between COVID-19 and anti-NMDA receptor encephalitis is discussed. miRNAs are small non-coding RNAs that play important roles in cell differentiation, development, cell-cycle regulation, and apoptosis. miRNAs have been used as biological biomarkers for many diseases. The results in this study reveal that the relationship between anti-NMDA receptor encephalitis and COVID-19 infection or COVID-19 vaccination cannot be excluded; however, the risk that COVID-19 triggers the anti-NMDA receptor encephalitis is not high.
Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , COVID-19 , MicroRNAs , Biomarkers , COVID-19 Vaccines , Female , Humans , Male , MicroRNAs/geneticsABSTRACT
Anti-N-methyl-D-aspartate receptor encephalitis is a clinical condition characterized by acute behavioral and mood changes, abnormal movements, autonomic instability, seizures, and encephalopathy. We describe a 7-year-old boy diagnosed with autoimmune encephalitis due to NMDAR antibody in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019) (COVID-19), without pulmonary involvement or fever. The patient presented with acute ataxia, rapidly developed encephalopathy, and autoimmune encephalitis was suspected. Steroid treatment was withheld because of lymphopenia and intravenous immunoglobulin was started. The absence of clinical response prompted plasmapheresis and, when lymphocyte counts improved, pulse steroid treatment was applied. The latter was followed by significant improvement and the patient was discharged in a conscious and ambulatory state. Autoimmune encephalitis should be considered in the presence of neurological symptoms accompanying SARS-CoV-2 infection and steroid treatment should be preferred unless limited by contraindications.