Post-Herpetic Anti-NMDAR Encephalitis in Denmark: Current Status and Future Challenges
It is well known that <i>N</i>-methyl-D-aspartate receptor encephalitis (NMDARE) can be triggered by infectious encephalitis such as herpes simplex virus 1 encephalitis (HSE). However, the incidence of post-HSE NMDARE in Denmark is unknown. We reviewed literature cases and compared these...
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2024-08-01
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| author | Anna Søgaard Charlotte Aaberg Poulsen Nadia Zeeberg Belhouche Alberte Thybo Siv Tonje Faret Hovet Lykke Larsen Christine Nilsson Morten Blaabjerg Mette Scheller Nissen |
| author_facet | Anna Søgaard Charlotte Aaberg Poulsen Nadia Zeeberg Belhouche Alberte Thybo Siv Tonje Faret Hovet Lykke Larsen Christine Nilsson Morten Blaabjerg Mette Scheller Nissen |
| author_sort | Anna Søgaard |
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| description | It is well known that <i>N</i>-methyl-D-aspartate receptor encephalitis (NMDARE) can be triggered by infectious encephalitis such as herpes simplex virus 1 encephalitis (HSE). However, the incidence of post-HSE NMDARE in Denmark is unknown. We reviewed literature cases and compared these to retrospectively identified cases of post-HSE NMDARE in Denmark, using a national cohort database of autoimmune encephalitis (AE) and two regional databases of infectious encephalitis patients. We identified 80 post-HSE NMDARE cases in the literature, 66% being children, who more often presented movement disorders, decreased consciousness, and sleep disturbances compared to adults. Eight patients with post-HSE NMDARE were identified from the national cohort database of AE, none being children. Forty-four HSE patients were identified from the regional infectious encephalitis databases. Of these, 16 (36%) fulfilled the Graus criteria for probable/definite NMDARE, and eight (18%) presented a prolonged/relapsing disease course. Ten (23%) were tested for AE during hospitalization. Six (14%) had leftover cerebrospinal fluid available for retrospective autoantibody testing. One out of these six patients (17%) harbored NMDARE antibodies. Thus, in total, nine post-HSE NMDARE patients have been identified in Denmark from 2009 to 2021. Comparing the adult Danish patients to the literature, Danish patients were older, but the clinical phenotype and paraclinical findings were similar. Overall, the incidence of adult post-HSE NMDARE in the Region of Southern Denmark was 0.17 per million people per year and only 7% of adult HSE patients in the region were diagnosed with post-HSE NMDARE. Our findings suggest that adult patients are still underdiagnosed and the absence of pediatric cases diagnosed with post-HSE NMDARE in Denmark is highly concerning. |
| format | Article |
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| language | English |
| publishDate | 2024-08-01 |
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| series | Biomedicines |
| spelling | doaj-art-138659d8a5eb42a5ab3842a09836c1da2025-08-20T01:56:05ZengMDPI AGBiomedicines2227-90592024-08-01129195310.3390/biomedicines12091953Post-Herpetic Anti-NMDAR Encephalitis in Denmark: Current Status and Future ChallengesAnna Søgaard0Charlotte Aaberg Poulsen1Nadia Zeeberg Belhouche2Alberte Thybo3Siv Tonje Faret Hovet4Lykke Larsen5Christine Nilsson6Morten Blaabjerg7Mette Scheller Nissen8Department of Clinical Research, University of Southern Denmark, 5230 Odense, DenmarkDepartment of Nuclear Medicine, Odense University Hospital, 5000 Odense, DenmarkDepartment of Clinical Research, University of Southern Denmark, 5230 Odense, DenmarkDepartment of Clinical Research, University of Southern Denmark, 5230 Odense, DenmarkDepartment of Clinical Research, University of Southern Denmark, 5230 Odense, DenmarkDepartment of Clinical Research, University of Southern Denmark, 5230 Odense, DenmarkDepartment of Clinical Research, University of Southern Denmark, 5230 Odense, DenmarkDepartment of Clinical Research, University of Southern Denmark, 5230 Odense, DenmarkDepartment of Clinical Research, University of Southern Denmark, 5230 Odense, DenmarkIt is well known that <i>N</i>-methyl-D-aspartate receptor encephalitis (NMDARE) can be triggered by infectious encephalitis such as herpes simplex virus 1 encephalitis (HSE). However, the incidence of post-HSE NMDARE in Denmark is unknown. We reviewed literature cases and compared these to retrospectively identified cases of post-HSE NMDARE in Denmark, using a national cohort database of autoimmune encephalitis (AE) and two regional databases of infectious encephalitis patients. We identified 80 post-HSE NMDARE cases in the literature, 66% being children, who more often presented movement disorders, decreased consciousness, and sleep disturbances compared to adults. Eight patients with post-HSE NMDARE were identified from the national cohort database of AE, none being children. Forty-four HSE patients were identified from the regional infectious encephalitis databases. Of these, 16 (36%) fulfilled the Graus criteria for probable/definite NMDARE, and eight (18%) presented a prolonged/relapsing disease course. Ten (23%) were tested for AE during hospitalization. Six (14%) had leftover cerebrospinal fluid available for retrospective autoantibody testing. One out of these six patients (17%) harbored NMDARE antibodies. Thus, in total, nine post-HSE NMDARE patients have been identified in Denmark from 2009 to 2021. Comparing the adult Danish patients to the literature, Danish patients were older, but the clinical phenotype and paraclinical findings were similar. Overall, the incidence of adult post-HSE NMDARE in the Region of Southern Denmark was 0.17 per million people per year and only 7% of adult HSE patients in the region were diagnosed with post-HSE NMDARE. Our findings suggest that adult patients are still underdiagnosed and the absence of pediatric cases diagnosed with post-HSE NMDARE in Denmark is highly concerning.https://www.mdpi.com/2227-9059/12/9/1953<i>N</i>-methyl-D-aspartate receptor encephalitispost-viral autoimmune encephalitisherpes simplex virus 1 Encephalitisautoimmune encephalitisviral encephalitis |
| spellingShingle | Anna Søgaard Charlotte Aaberg Poulsen Nadia Zeeberg Belhouche Alberte Thybo Siv Tonje Faret Hovet Lykke Larsen Christine Nilsson Morten Blaabjerg Mette Scheller Nissen Post-Herpetic Anti-NMDAR Encephalitis in Denmark: Current Status and Future Challenges Biomedicines <i>N</i>-methyl-D-aspartate receptor encephalitis post-viral autoimmune encephalitis herpes simplex virus 1 Encephalitis autoimmune encephalitis viral encephalitis |
| title | Post-Herpetic Anti-NMDAR Encephalitis in Denmark: Current Status and Future Challenges |
| title_full | Post-Herpetic Anti-NMDAR Encephalitis in Denmark: Current Status and Future Challenges |
| title_fullStr | Post-Herpetic Anti-NMDAR Encephalitis in Denmark: Current Status and Future Challenges |
| title_full_unstemmed | Post-Herpetic Anti-NMDAR Encephalitis in Denmark: Current Status and Future Challenges |
| title_short | Post-Herpetic Anti-NMDAR Encephalitis in Denmark: Current Status and Future Challenges |
| title_sort | post herpetic anti nmdar encephalitis in denmark current status and future challenges |
| topic | <i>N</i>-methyl-D-aspartate receptor encephalitis post-viral autoimmune encephalitis herpes simplex virus 1 Encephalitis autoimmune encephalitis viral encephalitis |
| url | https://www.mdpi.com/2227-9059/12/9/1953 |
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