Anti-NMDA-Receptor Encephalitis After Herpes Simplex Encephalitis in Children

This protocol addresses children who develop a relapse of neurologic symptoms following herpes simplex virus encephalitis (HSE) — a presentation known as post-HSE NMDA receptor antibody encephalitis. Distinguishing viral recurrence from an emerging autoimmune process is the critical first step in management.

Children presenting with renewed neurologic deterioration after HSE should receive acyclovir promptly, until herpes simplex virus encephalitis can be excluded based on the clinical picture and CSF findings. A high index of suspicion for an underlying autoimmune etiology must be maintained throughout.

Management centres on immunotherapy, applied in a manner analogous to the approach used for idiopathic NMDA-receptor encephalitis, with a structured progression of interventions.

The complete regimen — including specific agents, sequencing, and escalation criteria — is available in the full protocol below.