NMDAR Encephalitis in a Patient with NMO: A Double Hit without Cognitive Sequelae Following Treatment (P6.158)
Bibliographic record
Abstract
Objective: To describe the clinical, behavioral, and cognitive outcomes of an adolescent with Neuromyelitis optica (NMO) and N-methyl D aspartate receptor antibody encephalitis (NMDAR encephalitis). Background: There are rare reports of NMDAR encephalitis and NMO developing in the same adult. Here, we describe an adolescent who experienced both disorders 12 months apart and underwent cognitive testing during her course. Methods: Case report with data from an IRB approved database on pediatric demyelinating disorder Results: An 11 year old girl, born and raised in Anguilla, developed acute disseminated encephalomyelitis (ADEM) and seizures. She was brought to the USA, treated with intravenous (IV) steroids, anticonvulsants, and fully recovered. She returned home, did well socially and in school, but five years later, (9/2012) developed transverse myelitis, received IV steroids and had residual lower extremity increased tone and hyperreflexia. On 8/2013 she presented to the Lourie Center for Pediatric MS) seeking a diagnosis; NMO was confirmed with positive anti-aquaporin serology. Mental status was normal; symbol digit modality test (SDMT) raw score=79 (z score=2.5). She returned home, but came back one month later (9/2013), disoriented, confused and psychotic. She was hospitalized with catatonia. Toxicology screen was negative; neuroimaging abnormalities were unchanged. NMDAR encephalitis was confirmed with positive CSF antibody. On hospitalization her raw score SDMT=14 (z score= -5.0) and Montreal Cognitive Assessment score (MOCA)=17. Following plasmapheresis and rituximab her mental status improved. By (10/2013) raw score SDMT=43 (z score= -1.8); MOCA=25. Two years later, (9/2015); her mental status and behavior were back to her normal baseline: raw score SDMT=84 (z score=1.1), verbal memory on the Rey Auditory Verbal Learning Test raw score=70 (z score=2.5) and visual memory on the Brief Visual Memory Retention Test-Revised raw score=30 (z score=0.29). Conclusions: NMDAR encephalitis can follow pediatric NMO; full recovery of behavioral and cognitive function is possible.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".