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Guan et al. Neuroimmunol Neuroinflammation 2016;3:189-91 Neuroimmunology and
DOI: 10.20517/2347-8659.2016.29
Neuroinflammation

www.nnjournal.net
Case Report Open Access

D-cycloserin, a NMDA-agonist may

be a treatment option for anti-NMDAR

encephalitis

Hong-Zhi Guan , Tie-Kuan Du , Jin Xu , Xia Lv , Hua-Dong Zhu , Yi-Cheng Zhu , Bin Peng , Li-Ying Cui 1,3
1
1
2
1
2
2
1
1 Department of Neurology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
2 Department of Emergency, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
3 Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100730, China.
Correspondence to: Dr. Bin Peng, Department of Neurology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
100730, China. E-mail: pumchpengb@163.com
How to cite this article: Guan HZ, Du TK, Xu J, Lv X, Zhu HD, Zhu YC, Peng B, Cui LY. D-cycloserin, a NMDA-agonist may be a treatment
option for anti-NMDAR encephalitis. Neuroimmunol Neuroinflammation 2016;3:189-91.
ABSTRACT
Article history: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is caused by reversible neuron
Received: 15-06-2016 dysfunction associated an autoantibody-mediated decrease of NMDAR in the entire brain. A
Accepted: 12-07-2016 N-methyl-D-aspartate (NMDA) -agonist treatment for anti-NMDAR encephalitis might have a
Published: 31-08-2016 role considering its specific mechanism. The authors used D-cycloserine, a partial NMDA-agonist
in a refractory case with prolonged intensive care unit duration. A 13-year-old female presented
with headache, cognitive deterioration, generalized seizures, coma and hypoventilation with
Key words: required mechanical ventilation. Anti-NMDAR antibodies were identified in cerebrospinal
D-cycloserine fluid and serum confirming anti-NMDAR encephalitis. The patient was refractory to first-
encephalitis line and second-line immunotherapy and removal of ovary teratoma. D-cycloserine was then
autoantibody administered and her symptoms improved gradually and significantly. This is the first reported
N-methyl-D-aspartate receptor case in which D-cycloserine was applied to this disease. D-cycloserine might be a potential
agonist option as specific treatment in anti-NMDAR encephalitis.

INTRODUCTION encephalitis might have a role considering the
mechanism of NMDAR dysfunction in the disorder.
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis However, the current symptomatic medication, such
is caused by reversible neuron dysfunction associated as anti-epileptics and neuroleptic are usually less
autoantibodies against NMDAR. [1,2] Most cases with effective in anti-NMDAR encephalitis. Therefore,
anti-NMDAR encephalitis respond to immunotherapy. we think a N-methyl-D-aspartate (NMDA)-agonist
However, some cases are refractory to immunotherapy might be used to reverse its neuron dysfunction.
and have prolonged intensive care unit duration. [1] We reviewed the literatures on clinical application
Specific symptomatic treatment for anti-NMDAR of NMDA-agonists and found that D-cycloserine, a

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