Ho Chi Minh City warns of series of rare NMDAR autoimmune encephalitis cases

Ovarian cysts are no longer benign.

Patient Nguyen Van Anh (name changed, 17 years old) was found to have an ovarian tumor. Because she was still in school, although the doctor recommended early surgery because the tumor was too large, the family decided to let the patient finish her school schedule before proceeding with treatment.

During the delay in surgery, the patient suddenly had a seizure. Through clinical examination, the doctor discovered ovarian tumors on both sides, forcing the patient to undergo surgery twice in an attempt to save the less damaged ovaries by dissection.

When patient Van Anh had surgery at Cho Ray Hospital, Hung Vuong Hospital also coordinated to store eggs for the patient. Unfortunately, no eggs were saved, the patient was only allowed to store oocytes.

Dr. Huynh Thi Thuy Mai, Head of the Postpartum Department, Hung Vuong Hospital, Ho Chi Minh City, said: “This disease is really new to us, so we are trying to find out the cause. Ovarian dermoid cysts develop from the three outer layers of the embryo, when they become teratoma, they will have nerve tissue that creates antibodies against the baby's brain cells. According to research, the mother of patient Van Anh also had an ovarian cyst and had surgery, so the family thought this disease was normal. Even obstetricians and gynecologists are only concerned about whether the tumor is benign or malignant, and it is very rare for ovarian cysts to produce NMDAR autoimmune encephalitis antibodies.”

Studying the cause of the disease, doctors at Hung Vuong Hospital found that in 2023, more than 4,000 people were examined for ovarian teratoma, including about 600 surgeries, of which 98% were mature teratoma. Doctors are interested in immature tumors because of their high malignancy and potential to progress, while 98% of mature teratoma are benign. "Currently, obstetricians are neglecting an area called antibodies, so further research is needed in the future," said Dr. Thuy Mai.

If the disease is misdiagnosed or mistaken, the mortality rate is almost 100%.

In just 18 months, Cho Ray Hospital in Ho Chi Minh City has admitted 17 cases (12 women, 5 men) diagnosed with rare autoimmune encephalitis NMDAR. Notably, within 8 months, there were 9 cases, 4 of which are currently being treated.

Dr. Le Quoc Hung - Head of the Department of Tropical Diseases, Cho Ray Hospital (HCMC) - said that autoimmune encephalitis can occur in all ages and genders, but women are more susceptible than men. The disease mechanism is that the virus attacks nerve cells or tumors (usually ovarian teratoma containing nerve cell tissue) releasing NMDA antibodies, these antibodies attack the central nervous system causing brain damage at many levels, the patient will have seizures, coma, if not treated promptly or misdiagnosed, will die quickly.

In women, NMDAR autoimmune encephalitis is common in young women with ovarian teratoma. This disease is difficult to diagnose and requires a highly specialized medical facility with adequate equipment for diagnosis.

For men, the disease is often detected in patients with testicular tumors, feeling an unusual, painless hard lump or sharp pain in the scrotum. “We need to pay attention to clinical and paraclinical symptoms in 6 groups to aim for NMDAR autoimmune encephalitis: Abnormal behavior or cognitive disorders; Language dysfunction; Seizures; Movement disorders, dyskinesia, abnormal movements; Perceptual disorders (drowsiness, confusion, coma); Vegetative dysfunction, rapid breathing”.

Treatment costs up to billions of dong

Treatment of the disease is very difficult and requires the combination of many advanced techniques at the same time. When detected late, severe patients require long-term treatment and are very expensive. On average, a severe case that is completely cured costs more than 1 billion VND. Therefore, to quickly reduce the mortality rate related to NMDAR autoimmune encephalitis, experts say it is necessary to:

Screening for NMDAR antibodies in women with ovarian tumors.

Develop national standard diagnosis and treatment protocols.

People need to pay attention to early detection of signs of the disease.

Source: https://laodong.vn/suc-khoe/tp-ho-chi-minh-bao-dong-hang-loat-ca-mac-viem-nao-tu-mien-nmdar-hiem-gap-1360838.ldo