Work

Anti-N-methyl-D-aspartate receptor encephalitis: an emerging cause of centrally mediated sinus node dysfunction

Year: 2012

Type: article

Abstract: AIMS: Anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) is a recently recognized form of autoimmune encephalitis that typically affects young women, often as a paraneoplastic syndrome related to ovarian teratoma. Clinical features include psychiatric and neurological disturbances, central hypoventilation, autonomic instability, and cardiac dysrhythmias. The prevalence, nature, and outcomes of cardiac dysrhythmias in patients with NMDARE have not been well described. METHODS AND RESULTS: Records of 10 consecutive patients with NMDARE were reviewed to obtain clinical, laboratory, echocardiographic, electrocardiographic, and radiological data. Patients were all female with an average age of 23 ± 5.5 years. Echocardiograms revealed structurally normal hearts with the exception of mild left ventricular hypertrophy in two cases. Eight patients had inappropriate sinus tachycardia. Six patients developed significant sinus bradycardia, which included periods of sinus arrest in four cases. Five patients manifested both sinus bradycardia and tachycardia. Bradycardia was often triggered by identifiable vagal stimuli. Temporary pacing was instituted in three patients, but permanent pacing was not required in any of the patients. Magnetic resonance imaging (MRI) scans revealed mesial temporal abnormalities in nine patients. In all cases, the dysrhythmias resolved with treatment of the underlying immune disorder with immunotherapy and/or teratoma resection. There was no evidence of dysrhythmia recurrence in any patient at follow-up. CONCLUSION: Anti-N-methyl-D-aspartate receptor encephalitis is a recently recognized cause of autoimmune encephalitis with a predilection to cause severe sinus node abnormalities. Temporary pacing is occasionally required, but permanent pacing appears to be unnecessary. An analysis of the clinical syndrome coupled with MRI and experimental data may offer insight into central mechanisms of heart rate regulation.

Source: EP Europace

DOI: 10.1093/europace/eus014

Authors: T. M. Nazif, J. Vazquez, L. S. Honig, J. M. Dizon

Institutions: Columbia University Irving Medical Center, Columbia University

Language: English

Topic: Autoimmune Neurological Disorders and Treatments

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funders: National Institutes of Health, National Institute on Aging