[Movement disorders in anti-N-NMDA receptor encephalitis]. / Bewegingsstoornissen bij anti-NMDA-receptorencefalitis.

BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis (anmdare) is a serious disease, that has only been known since 2007; movement disorders form part of the neuropsychiatric symptomatology. AIM: To provide an overview of movement disorders in anmdare and to emphasise the complexity of this disease with regard to diagnostics and treatment. METHOD: We searched the literature using PubMed, Medline and Cochrane and the search terms 'Anti-N-Methyl-D-Aspartate Receptor Encephalitis' OR 'anti-nmda receptor encephalitis' OR 'anti-nmdar encephalitis' AND 'movement disorders' OR 'catatonia'. RESULTS: Orofacial dyskinesia is the most characteristic movement disorder in anmdare. Dyskinesia was observed in 80% of the patients; young children (<12 years old) have movement disorders more often. CONCLUSION: Movement disorders are typical but aspecific symptoms of anmdare. More than one movement disorder is present in nearly all cases, a factor that can make early diagnosis difficult and can delay the start of appropriate treatment.

[Anti-NMDA-receptor encephalitis: a new axis-III disorder in the differential diagnosis of childhood disintegrative disorder, early onset schizophrenia and late onset autism]. / Anti-NMDA-receptorencefalitis: een nieuwe as III-stoornis in de differentiaaldiagnose van desintegratiestoornis van de kinderleeftijd, vroeg optredende schizofrenie en laat optredend autisme.

Childhood disintegrative disorder (CDD), early onset schizophrenia (EOS), and late onset autism (LOA) often follow a similar course: initially, development is normal, then there is a sudden neuropsychiatric deterioration of social interaction and communication skills, which is combined with a decline in intelligence and reduction in daily activities. A 9-year-old boy was admitted to the paediatric ward with acute onset of secondary epileptic seizures. It was not long until the boy's symptoms resembled that of patients with cdd, eos and loa. Intensive tests led to the diagnosis of anti-NMDA-receptor encephalitis. Anti-NMDA-receptor encephalitis should be regarded as a possible organic cause underlying the syndromal presentation of CDD, EOS and LOA.

[Delirium in critically ill children in a paediatric intensive care unit]. / Delier bij kritisch zieke jonge kinderen op een pediatrische intensivecareafdeling.

Two critically ill girls, aged 2.3 years and 3.5 years respectively, developed delirium in the Paediatric Intensive Care Unit (PICU). The first child, admitted with meningococcal meningitis and septic shock with respiratory failure, suffered from hyperactive delirium which started 2 hours post-extubation. The second child, admitted due to an exacerbation of cystic fibrosis with the threat of respiratory failure, suffered from hypoactive delirium with regression, inconsolability, dyspraxia and dysphasia. Both patients responded well to a single intravenous dose of haloperidol. Although delirium occurs in critically ill children, it often goes unrecognized, particularly in its hypoactive form. It should nevertheless be considered as a medical emergency, particularly in a PICU setting, and should be treated accordingly. Physicians are generally reluctant to consider psychopharmacological treatment of childhood delirium. Haloperidol is considered as the drug of choice, but risperidone can also be used successfully.