NMDA Receptor Encephalitis With Severe Orofacial Dyskinesias Treated With Tramadol and Clonazepam

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