It is indeed a miracle for 15year old Priyam Wada Chettri. She was suffering from NMDA-R Encephalitis which had only been discovered in 2005. It is a rare viral disease usually found in 10-40year olds. NMDA-R encephalitis is auto-immune disease, found in the young set of patients; however the youngest age reported is two years. The common symptoms include:
• Behavioural abnormality
• Hyper kinetic movement disorder
• Autonomic dysfunction
• Altered sensorium
These symptoms are often confused with typical virus encephalitis. Diagnosis is aided by MRI Brain, NMDA-R receptor-antibody in serum & CSF along with other ancillary tests but high index of suspicion is utmost important because this is a very rare disease. Treatment is mainly IVIG and other supportive care. Outcome is reasonably good however recovery may take several months. Priyam has recovered in a month; this is an incredible remark to the doctor whose professional expertise has proved its outcome.
Dr. Swayam Prakash, Consultant Neurologist at Neotia Getwel Health care Centre in his concerned tone suggested, “Neurologists should start doubting such cases where typical presentation of viral Encephalitis is not present, where symptoms as mentioned above are not clear enough especially abnormal involuntary movements, making treatment started before the condition deteriorates, especially in the younger set of patients, higher index of suspicion should be maintained”.
Ms. Priyam Chettri presented with a two weeks history of disturbed sleep, behavioural abnormality, 3 episodes of GTCS (generalized tonic colonic seizure) spread over 4 days, followed by altered sensorium. No history of headache, fever or vomiting was there. Her GCS (Glasgow Coma Scale) was further worsening for which she was intubated and put on mechanical ventilation. Several tests were taken, MRI brain report showed – signal changes in bilateral cingulate gyri posterior occipito-temporal lobes and right parahippocampal gyrus. MRI Spine screening was within normal limits, Dengue serology, malaria antigen and typhi dot tests were negative. Based on clinico-historical-radiological-pathological observation a tentative diagnosis of encephalitis syndrome was made and treatment was initiated on that line with proper antibiotics, antiviral, antipyretic, antiepileptic and other supportive care. Doctor noticed various types of abnormal involuntary movements like facial dyskinesia, multiple choreiform movements. She also developed marked autonomic dysfunction, so a possibility of autoimmune encephalitis was thought of and NMDA-R ab and anti VGKC-ab were sent. Even though the test results were not revealed but on the patients deteriorating condition doctor had already proceeded with the treatment. When the treatment was half its way the tests reports were despatched and NMDA-R ab came positive.
The strong technical and professional experience of the doctor that helped him diagnose and start with early treatment even before the test reports were revealed had only helped that the patient revive from the ailment and be given right medication at the right time.
“It’s like a rebirth for my daughter. I am 101 per cent satisfied. I am short of words to express my gratitude and thankfulness for the entire team who gave my daughter a second life“, expressed mother of Priyam, Yasoda Chettri. “Priyam is now in a stabilized condition, and doing quite well, her recovery in a short period indicates her wellness. She will be in our constant follow up,” says Dr. Swayam Prakash.