抗NMDA受體腦炎合併重積型癲癇：一病例報告

Anti-NMDA Receptor Encephalitis with Status Epilepticus: A Case Report

10.6320/FJM.201809_22(5).0003

陳蓉芳(Jung-Fang Chen)；沈修年(Hsiu-Nien Shen)；楊浚銘(Chin-Ming Yang)；蘇慧真(Hui-Chen Su)

抗NMDA受體腦炎 ； 重積型癲癇 ； Anti-N-methyl-D-aspartate receptor encephalitis ； status epilepticus

台灣醫學

22卷5期（2018 / 09 / 25）

482 - 485

繁體中文

抗NMDA受體腦炎是一種自體免疫疾病，症狀包括行為異常記憶障礙、運動障礙、精神症狀、癲癇、呼吸衰竭等。此疾病與女性卵巢畸胎瘤相關，該疾病最重要的治療關鍵是早期診斷和早期治療。治療以早期切除腫瘤，並積極使用免疫療法，可提升治療結果。本案例為26歲女性無過去病史，近兩日有發燒、局部癲癇、小便失禁、精神症狀，且有呼吸短促等情形。住院期間個案出現臉部抽搐及重積型癲癇；經使用免疫抑制劑、高劑量抗癲癇藥物、血漿置換術及切除腫瘤後，症狀明顯進步。

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder. Clinical presentation includes behavior, memory, motor dysfunction, psychiatric symptoms, seizure and hypoventilation. The disorder has been previously associated with ovarian teratoma which particularly females. Confirmation of anti-NMDAR encephalitis is the key to early diagnosis and prompt treatment, which may alter the course of the disease. Early tumor removal and aggressive immunotherapy is the key to improved clinical outcomes. We present the case of a 26-year-old female, with no known prior medical problems. Two days after admission, she developed fever, focal seizure, urine incontinence, psychiatric symptoms, and dyspnea. On admission to our hospital, she presented with involuntary orofacial movements and refractory status epilepticus. The patient's status epilepticus and psychotic symptoms, markedly improved following immunotherapy, high dose anti-epilepitic drugs, plasma exchange and removal teratoma.