ANTIPSYCHOTICS IN ANTI-NMDAR ENCEPHALITIS BEFORE IMMUNOTHERAPY

We included patients from the ANMDARE cohort at the National Institute of Neurology and Neurosurgery of Mexico (NINN) assessed between 2014 and 2022, who received psychiatric attention and symptomatic treatment with antipsychotic medications before the referral to our Institution, before a formal ANMDARE diagnosis, and before the administration of immunotherapy. All patients underwent a comprehensive diagnostic evaluation, including extensive bloodwork, EEG, MRI, and lumbar puncture studies, to exclude other potential causes, and to ascertain the presence of anti-NMDAR antibodies in cerebrospinal fluid (CSF). Patients were diagnosed as having possible, probable and definite autoimmune psychosis according to the Pollak et al criteria,4 and classified as having or not a significant adverse reaction to antipsychotic medication, raising the suspicion of NMS, according to the Pollak et al criteria, which consider three variables: hyperthermia, generalized rigidity, and elevation of CPK. A full diagnosis of NMS was done by means of the DSM-5 and the Caroff et al recommendations.