Treatment of Anti-NMDA-receptor Encephalitis in Children with Neurologic Relapse After Herpes Simplex Encephalitis

Children who have recovered from herpes simplex virus encephalitis (HSE) may experience a subsequent relapse of neurologic symptoms. This presentation may not represent viral recurrence but instead a post-HSE NMDA-receptor antibody encephalitis — an autoimmune condition triggered in the setting of prior HSE that demands a distinct diagnostic and management approach.

A prior episode of herpes simplex encephalitis is the defining comorbidity for this protocol. When neurologic symptoms recur or worsen after HSE, clinicians face the critical challenge of distinguishing viral recurrence from an emerging autoimmune etiology. A high index of suspicion for an underlying autoimmune cause must be maintained throughout the initial evaluation.