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Paraneoplastic encephalitis associated with ovarian teratoma and N‐methyl‐d‐aspartate receptor antibodies

Sir, Recently, a new category of paraneoplastic encephalitis associated with ovarian teratoma (OTE) has been described.[1] This disorder results in prominent psychiatric symptoms, seizures, autonomic dysfunction, dyskinesias and hypoventilation, and associates with antibodies to NR1/NR2 heteromers of the N-methylD-aspartate receptor (NMDAR).[1,2] We lately described the clinical features of four patients with OTE, but the presence of these antibodies was not determined.[3] We now report the presence of these antibodies in archived frozen CSF of three of the patients with OTE. All three patients (three women; age range 17–29 years, mean 20.7 ± 7.2 years) developed psychiatric symptoms, central hypoventilation requiring prolonged ventilatory support (range 30–44 days), seizures, involuntary movements, and autonomic instability associated with cardiac arrhythmias (bradycardia-tachycardia syndrome in three and sinus arrest in one) or hypersalivation. These neurological disorders preceded the diagnosis of ovarian teratoma. On neuroimaging studies, only one patient showed hyperperfusion in whole brain on perfusion MRI. The white blood cell count in cerebrospinal fluid was 47.0 ± 35.6/mm. Mature teratoma was diagnosed in all patients after ovarian tumor resection. They received immunotherapy: three patients received corticosteroids, two received intravenous immunoglobulins, and showed complete recovery (see[3] for details). Immunocytochemical studies were performed as reported.[1] In brief, HEK 293 cells were transfected with NR1 and NR2 plasmids in order to express NR1/NR2