LETTER TO THE EDITORS Spontaneous recovery from anti-NMDAR encephalitis Amelia Evoli • Pietro Spinelli • Giovanni Frisullo • Paolo E. Alboini • Serenella Servidei • Camillo Marra Received: 22 December 2011 / Revised: 30 January 2012 / Accepted: 7 February 2012 / Published online: 3 March 2012 Ó Springer-Verlag 2012 Dear Sirs, Encephalitis associated with antibodies (Abs) to the N-methyl-D-aspartate receptor (NMDAR) can occur in a paraneoplastic or non-paraneoplastic form. It is character- ized by a broader clinical spectrum than typical limbic encephalitis, generally presenting with psychiatric symp- toms, progressing to seizures and movement disorders, up to coma with hypoventilation [1, 2]. Although early treat- ment, based on tumor removal, when appropriate, and immunotherapy is associated with positive outcome, many patients require prolonged hospitalization and respiratory assistance [3]. We report a young woman with non-para- neoplastic anti-NMDAR encephalitis who experienced spontaneous recovery. Neuropsychological evaluation was performed with a test battery including mini mental state examination and tests exploring episodic memory (Rey’s auditory verbal learning test), short-term memory (digit and visual–spatial span), language [phonological word fluency, semantic word fluency (SWF)], object naming, executive functions (Stroop test), constructional praxis (copy of figures with and without landmarks), attention (multiple features targets cancellation) and intelligence tasks (Raven’s colored matrices ‘47). Abs in samples taken at presentation were assayed by Prof. Vincent; these and subsequent samples were re-tested with a commercial assay (Euroimmun, Lu ¨beck, Germany). In September 2007, a 27-year-old Romanian woman was admitted to another hospital on the grounds of mild fever, confusion, extreme anxiety, and fear, followed, in a few days, by tonic–clonic seizures. Brain MRI was unre- markable and CSF analysis showed a mild increase in protein content (76 mg/dl) and lymphocytosis (25 cells/ field). The patient was transferred to our hospital Depart- ment of Infectious Diseases, where a new CSF evaluation showed normal glucose, proteins 84 mg/dl, 2 cells/field; no oligoclonal bands. Treatment with phenobarbital and carbamazepine was started and, after exclusion of an infectious etiology (negative PCR for Mycobacterium tuberculosis, VZV, HSV, enterovirus, EBV, CMV on both CSF and serum; negative HIV-serology), the patient was admitted to our department. Brain MRI detected a T2 and FLAIR signal hyperintensity in the left temporal mesial lobe and insula (Fig. 1a). EEG showed slow activity in the left hemisphere. Neurological examination was unremark- able except for confusion, ideomotor slowing, and verbal reduction; dyskinesias, dystonia, rigidity, autonomic and breathing instability were not detected. Neuropsychologi- cal evaluation showed a multitask cognitive impairment mainly consisting of retrograde amnesia and lexical and semantic language disorder (see Table 1). In the following weeks, the patient’s cognitive status and brain MRI improved spontaneously. Of an extensive Ab panel, including anti-Hu, -AMPAR, -CASPR2, -GABAR1 and -LGI1 Abs, NMDAR Abs were positive in CSF and serum. At the first control visit, in November 2007, the patient still showed an impairment of language abilities, with partial recovery of memory function (see Table 1). The patient’s conditions remained stable until January 2008, when two generalized seizures occurred, possibly because of therapy Electronic supplementary material The online version of this article (doi:10.1007/s00415-012-6457-y) contains supplementary material, which is available to authorized users. A. Evoli (&) Á P. Spinelli Á G. Frisullo Á P. E. Alboini Á S. Servidei Á C. Marra Institute of Neurology, Catholic University, Largo F. Vito 1, 00168 Rome, Italy e-mail: a.evoli@rm.unicatt.it 123 J Neurol (2012) 259:1964–1966 DOI 10.1007/s00415-012-6457-y