Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal.

OBJECTIVE: To report the definitive diagnosis of anti-NMDA receptor (NMDAR) encephalitis in four Japanese women previously diagnosed with "juvenile acute nonherpetic encephalitis" of unclear etiology, and to describe their long-term follow-up in the absence of tumor resection. METHODS: We extensively reviewed the case histories with current clinical and laboratory evaluations that include testing for antibodies to NR1/NR2 heteromers of the NMDAR in serum/CSF available from the time of symptom onset (4 to 7 years ago) and the present. RESULTS: All patients sequentially developed prodromal symptoms, psychosis, hypoventilation, severe orofacial dyskinesias, and bizarre immunotherapy-resistant involuntary movements that lasted 1 to 12 months. Two patients required mechanical ventilation for 6 and 9 months. Initial tests were normal or unrevealing, including the presence of nonspecific CSF pleocytosis, and normal or mild changes in brain MRI. Eventually, all patients had dramatic recovery of cognitive functions, although one had bilateral leg amputation due to systemic complications. Antibodies to NR1/NR2 heteromers were found in archived serum or CSF but not in long-term follow-up samples. An ovarian teratoma was subsequently demonstrated in three patients (all confirmed pathologically). CONCLUSION: 1) These findings indicate that "juvenile acute nonherpetic encephalitis" or a subset of this disorder is mediated by an antibody-associated immune response against NR1/NR2 heteromers of the NMDA receptor (NMDAR). 2) Our patients' clinical features emphasize that anti-NMDAR encephalitis is severe but potentially reversible and may precede by years the detection of an ovarian teratoma. 3) Although recovery may occur without tumor removal, the severity and extended duration of symptoms support tumor removal.

[Projective movements in emotionally comfortable and uncomfortable states].

UNLABELLED: Aiming to examine the function of projection as a part of human cognitive behavior, this study focused on studying how an emotional factor affects projective movements by analyzing the quality of the movements. SUBJECTS: Sixty junior college women. Visual stimuli: Sixteen unambiguous figures. Emotional states: As induced by comfortable, uncomfortable sounds, or neutral state. The subjects were randomly divided into three emotionally different groups. Then stimulus slides were projected in a random order on a screen. Each stimulus was evaluated in terms of the amount, speed, and direction of its projectively perceived movement. RESULTS: 1. A highly positive correlation was found between the emotional state and the amount of projected movements. 2. With regard to the speed and direction of projected movements, significant differences were found among the three groups of subjects and among the stimuli. CONCLUSIONS: 1. When considering the effect of emotional states on projected movements, the quality (speed and direction) of the movements, in addition to their amount alone, should be taken into account. 2. Under emotionally uncomfortable conditions, the speed and direction are mutually complementary as a means of protection against anxiety.