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NMDAR-antibody encephalitis is a life-threatening neuropsychiatric condition, with symptoms including seizures and movement disorders. Because its early symptoms include psychiatric disturbance, such as hallucinations, and the fact it often appears in young people, the initial clinical impression may be of a psychosis, which has different treatment approaches to encephalitis.
NMDAR-antibody encephalitis can only be definitively diagnosed by sampling cerebrospinal fluid (CSF) through a procedure called lumbar puncture. While safe, lumbar puncture is more invasive than blood tests and not offered by most mental health services, instead usually requiring a neurology team to review and consider carrying out the procedure.
To help facilitate this clinical conversation, an international collaborative team of scientists and clinicians led by Dr Adam Al-Diwani at the University of Oxford, supported by the National Institute of Health and Care Research (NIHR) Oxford Health Biomedical Research Centre, Professor Daniel Joyce, Co-Director at the NIHR Mental Health Research for Innovation Centre at the University of Liverpool and Mersey Care NHS Foundation Trust, and Professor Sarosh Irani at Mayo Clinic Florida, have identified features and suggest a scoring system that could help doctors in frontline medical and mental health services identify in which patients CSF sampling should be considered.