Is anti-NMDA receptor encephalitis real? II. Therapeutic challenges

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Abstract

The first part of the review challenges the diagnostic concept of anti-NMDA receptor encephalitis (ANMDARE). The second part focuses on analyzing current therapeutic approaches. It is demonstrated that the use of antipsychotics or immunosuppressants poses the risk of severe complications, potentially leading to fatal outcomes, in the near or distant future. Comparing clinical and neurobiological effects associated with antibodies to the GluN1 subunit of the glutamate N-methyl-D-aspartate receptors (NMDAR1-AB) and the administration of subanesthetic doses of the non-competitive NMDA receptor antagonist Ketamine highly suggests a neuroprotective, health-promoting role of NMDAR1-AB, which should not be suppressed but rather potentiated. Benzodiazepines and electroconvulsive therapy (ECT) remain the treatment of choice for acute polymorphic hyperkinetic psychoses.

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About the authors

Evgeny V. Snedkov

Psychiatric Hospital of St. Nicolas Wonderworker

Email: esnedkov@mail.ru
ORCID iD: 0000-0002-1438-1890
SPIN-code: 4353-6428

MD, Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg

Igor A. Volchek

Federal State Budgetary Educational Institution of Higher Education Russian Biotechnological University; Research Center for Immunology and Allergology

Email: igor.volchek@gmail.com
ORCID iD: 0009-0000-1451-6145
SPIN-code: 6743-2105

д-р мед. наук, профессор; главный научный сотрудник научно-исследовательского центра иммунологии и аллергологии

Russian Federation, Moscow; Moscow

Ilia V. Lemeshev

Psychiatric Hospital of St. Nicolas Wonderworker; North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: ilya.lemeshev@gmail.com
ORCID iD: 0009-0002-0491-6545
SPIN-code: 7635-4548

MD, Head of the Day Hospital Department, Psychiatrist; Assistant Professor

Russian Federation, St. Petersburg; St. Petersburg

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