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This important article describes a sensitive cell-based assay for antibodies to the N-methyl-d-aspartate (NMDA) receptor, which have recently been associated with an encephalopathy in both children and adults.
Of 450 encephalopathic patients with serum samples, 50 had positive test results for NMDA antibodies; other diagnostic modalities had failed to identify the cause. The average hospital stay was 160 days; patients had “long periods of ventilation and multiple infectious complications.” The clinical course (tracked in 44 patients) was biphasic, consisting of cognitive symptoms and seizures followed by extrapyramidal and autonomic signs and coma. Only 20% of these case patients were paraneoplastic, and in these the encephalopathy responde…