Department of Neurology Chang Gung Memorial Hospital College of Medicine Chang Gung University Keelung Taiwan.
Community Medicine Research Center Keelung Chang Gung Memorial Hospital Keelung Taiwan.
Brain Behav. 2017 Aug 1;7(9):e00779. doi: 10.1002/brb3.779. eCollection 2017 Sep.
Autoantibodies to the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor and -methyl-d-aspartate (NMDA) receptor are known to be the causes of autoimmune encephalitis particularly limbic encephalitis. The involvement of the peripheral nervous system is rarely reported.
We analyzed the serial nerve conduction studies of a previously reported case of anti-AMPA receptor encephalitis, who was presented with conscious disturbance and quadriplegia. Initial nerve conduction studies (NCS) revealed motor axonal polyneuropathy with active denervation. We also performed systematic review of similar cases with overlapped peripheral neuropathy and glutamate receptor encephalitis through Embase, PubMed, and MEDLINE.
Follow-up NCS of the patient with anti-AMPA receptor encephalitis found reverse of the acute neuropathy, which was compatible with clinical recovery of quadriplegia. The systematic review identified 10 cases with overlapping peripheral neuropathy with anti-AMPA or NMDA receptor encephalitis. Motor or sensorimotor neuropathies were more common than pure sensory neuropathies. Anti-Hu, anti-amphiphysin, or anti-gnaglioside antibodies coexisted in some cases and might be associated with the peripheral symptoms.
Both anti-AMPA and anti-NMDA receptor encephalitis could overlap with acute peripheral neuropathy. It is important to consider peripheral symptoms and perform diagnostic tests.
已知针对α-氨基-3-羟基-5-甲基-4-异恶唑丙酸（AMPA）受体和 -甲基-d-天冬氨酸（NMDA）受体的自身抗体是自身免疫性脑炎，特别是边缘性脑炎的病因。涉及周围神经系统的情况很少见报告。
我们分析了先前报道的抗 AM-PA 受体脑炎病例的连续神经传导研究，该患者表现为意识障碍和四肢瘫痪。初始神经传导研究（NCS）显示运动轴索性多发性神经病伴活跃去神经支配。我们还通过 Embase、PubMed 和 MEDLINE 对伴有重叠周围神经病和谷氨酸受体脑炎的类似病例进行了系统回顾。
抗 AM-PA 受体脑炎患者的随访 NCS 发现急性神经病逆转，与四肢瘫痪的临床恢复相吻合。系统回顾确定了 10 例伴有重叠周围神经病的抗 AM-PA 或 NMDA 受体脑炎。运动或感觉运动神经病比单纯感觉神经病更常见。在某些情况下，抗 Hu、抗 amphiphysin 或抗神经节苷脂抗体共存，可能与周围症状有关。
抗 AM-PA 和抗 NMDA 受体脑炎均可与急性周围神经病重叠。重要的是要考虑周围症状并进行诊断性检查。
