Autism Associated with Anti-NMDAR Encephalitis

June 25, 2020

Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. There are many subtypes of autism, most influenced by a combination of genetic and environmental factors.

The current prevalence of ASD is estimated to be 1.5% or higher in developed countries.  At least 69% of individuals with a diagnosis of ASD have neuroinflammation or encephalitis.  A group in China led by Dr. Hsien-Yuan Lan introduces ‘autoimmune autism’ to describe the potential pathogenicity of autism, which could explain why autoimmune dysfunction leads to autistic symptoms.

Patients who develop autoimmune autism early in life may be misdiagnosed, particularly if their anti-NMDAR encephalitis or potential autoimmune-related disease remains unrecognized. Autoimmune autism requires immune therapy; therefore, earlier detection is essential to prevent a misdiagnosis of autism. In addition to a maternal or childhood history of infection, the discovery of autoantibody, cytokines, decreased lymphocytes, imbalance of serum immunoglobulin levels, and T-cell-mediated immune profile, can all be biological markers of autoimmune autism.

Autoimmune autism (including diagnosis of anti-NMDAR encephalitis or other autoimmune dysfunctional encephalitides), should be considered a possible cause in children with the underlying syndrome presentation of childhood disintegrative disorder, early-onset schizophrenia, or late-onset autism.  Equally, autoimmune autism should be considered in children with a first episode of psychosis and especially when autistic symptoms follow a febrile (feverish) illness.

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