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- W4313642056 abstract "Objective N/A. Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory disease mediated by antibodies targeting the GluN1 subunit of the NMDAR. It presents with well-defined neuropsychiatric symptoms, including psychosis, agitation, seizures, and memory disturbances.1 Movement disorders including orofacial dyskinesias are common, but often difficult to manage, with no specific published guidelines. 1,2,3 Design/Methods A 23-year-old female was diagnosed with NMDAR encephalitis. She was treated with ovarian teratoma removal, corticosteroids, intravenous immunoglobulin therapy, rituximab, and tocilizumab. She continued to experience severe, self-mutilating orofacial dyskinesias. Tetrabenazine, haloperidol, and diazepam did not yield any sustained improvement. Tramadol was started based on prior case reports suggesting its efficacy as well as clonazepam. 3 Results Tramadol 50 mg po q6h led to immediate improvement in symptoms. Over the next 5 days, tramadol was increased to 150 mg NG q6h and further reduced movements. When tramadol was held for one day, the movements significantly worsened and improved when it was restarted. Clonazepam 1 mg NG QID also led to further improvement. Conclusions Tramadol and clonazepam effectively treated severe orofacial dyskinesias in a patient with NMDAR encephalitis and refractory symptoms despite aggressive management. We propose early use of tramadol and clonazepam be considered for severe orofacial dyskinesias secondary to NMDAR encephalitis." @default.
- W4313642056 created "2023-01-07" @default.
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- W4313642056 date "2022-12-05" @default.
- W4313642056 modified "2023-09-28" @default.
- W4313642056 title "NMDA Receptor Encephalitis With Severe Orofacial Dyskinesias Treated With Tramadol and Clonazepam" @default.
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- W4313642056 doi "https://doi.org/10.1212/01.wnl.0000903220.64631.0e" @default.
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