American Board of Internal Medicine (ABIM) Certification Practice Exam

What treatment is generally indicated for anti-NMDAR antibody encephalitis?

1. Antibiotics for secondary infections

2. Removal of the teratoma and immunosuppression

3. Long-term corticosteroid therapy

4. Monoclonal antibody therapy

The correct answer is: Removal of the teratoma and immunosuppression

Anti-NMDAR antibody encephalitis is an autoimmune condition characterized by psychiatric symptoms, seizures, and movement disorders, often linked to the presence of teratomas, particularly in young women. Management of this condition primarily focuses on two crucial interventions: addressing the underlying cause, which is often a teratoma, and administering immunosuppression to mitigate the effects of the autoimmune response. The removal of the teratoma is significant because it can not only alleviate the production of NMDAR antibodies but also lead to substantial improvement in neurological symptoms. Immunosuppression typically involves corticosteroids, intravenous immunoglobulin (IVIG), and/or plasmapheresis, which help to reduce antibody-mediated effects. This dual approach of addressing both the tumor and the autoimmune response is essential in the treatment strategy for patients with anti-NMDAR antibody encephalitis. Other treatments, such as antibiotics, long-term corticosteroid therapy alone, or exclusively monoclonal antibody therapy, do not directly address the root cause of the encephalitis or may not provide the comprehensive care needed for effective management of the condition.