Neurology CP: Enteral trastis for movement disorders against NMDAR encephalitis

Anti-NMDA receptor (NMDA receptor) encephalitis is the most common autoimmune encephalitis
caused by IgG antibodies against NMDAR NR1 sub-sub-IgG.

Research content

Movement disorders are one of
the most intractable symptoms of NMDAR encephalitis.

Severe dyskinesias can lead to self-injury, falls, and sometimes even rhabdomyolysis
.

Diazepam has the properties of muscle relaxation and has been used in certain spasm-based conditions such as antipsychotic malignant syndrome (NMS), stiff human syndrome, and tetanus
.

In August 2021, Hye-Rim Shin et al.

They reviewed NMDAR encephalitis patients
with movement disorders who stayed at Seoul National University Hospital between November 2012 and July 2018.

Of the 68 patients with NMDAR encephalitis, 33 patients received intestinal zepam
.

The starting dose of diazepam averages 12.

The average time from the beginning of taking diazepam (titration duration) to reaching the highest dose is 25.

The strategy for titration to the highest dose varies greatly and depends on clinical severity
.

For example, a 22-year-old woman with refractory dyskinesias began with 4 mg of diazepam 3 times a day and doubled the dose per day for 3 consecutive days to 16 mg
3 times a day.

In 50-year-old male patients, starting with 5 mg of diazepam once a day, the next day increases to 4 mg
3 times a day.

Twenty-nine patients (87.

After taking the highest dose of diazepam for 1 week, the severity of dyskinesia decreased from an average of 2.

In summary, the authors believe that after treatment with enteric zepam, the movement disorders of NMDAR encephalitis patients have improved without significant side effects
.