Journal of Neurology and Psychology

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Case Study

A Twenty Two Months Toddler of Anti-NMDA Receptor Encephalitis Presenting with Total Insomnia for 4 days: The First Toddler Case in World Literature

Muzaffar A, Sadia SJ, Nazar A and Malik MA*

Department of Neuropediatrician the Brain Associates, Multidisciplinary Paediatric Neurosciences Clinic. 218 D. Model Town Lahore-Pakistan
*Address for Correspondence:Muhammad Akbar Malik, Department of Neuropediatrician the Brain Associates. Multidisciplinary Paediatric Neurosciences Clinic. 218 D. Model Town Lahore-Pakistan, E-mail Id: docmalikpk2000@yahoo.co.in
Submission: May 05, 2026 Accepted: July 04, 2026 Published: July 10, 2026
Copyright: ©2026 Muzaffar A, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Autoimmune encephalitis; Cerebrospinal fluid; AntiNMDAR autoimmune encephalitis; Psychosis; Insomnia

Abstract

Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARe) is the most frequent autoimmune encephalitis in children and may cause long-term sequelae. It is caused by antibodies directed against the RN1 or RN2 subunits of NMDA receptors. It is characterized by a prodromal phase of unspecific illness with fever that resembles a viral disease. The prodromal phase is followed by seizures, disturbed consciousness, psychiatric features, prominent abnormal movements, and autonomic imbalance. Here, we report a rare case of anti-NMDARe in a 22 months-old girl visited our multidisciplinary neurosciences clinic due to drug resistant total insomnia and aggression for four days without any other prodromal symptoms. The cerebrospinal fluid tested positive for anti-NMDAR antibodies and no association with teratoma or thymoma was found. The patient was treated with intravenous corticosteroid and immunoglobulin therapy concomitantly, which resulted in a prompt clear clinical improvement as she regained the ability to eat, sleep and social interaction with resumption, without behavioral disturbance and was discharged after 7 days from the hospital.