Background and objectives. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, first described in 2007, is now one of the most common autoimmune encephalitides. It primarily affects young individuals, especially females, and typically presents with a progression of neuropsychiatric symptoms. This narrative review synthesizes recent clinical insights into its epidemiology, pathogenesis, presentation, and treatment options. Materials and methods. We reviewed 50 key publications on anti-NMDAR encephalitis published between 2007 and 2025, using PubMed and Web of Science. Priority was given to high-quality clinical studies and consensus guidelines. Results. The illness typically follows a multiphasic course, with psychiatric features (e.g., psychosis, catatonia) followed by seizures, memory deficits, dyskinesias, and autonomic instability. Around half of patients, particularly young women, have an associated tumor – most commonly ovarian teratoma. Diagnosis is based on detection of CSF NMDAR antibodies, supported by EEG and sometimes MRI findings. First-line immunotherapy (high-dose corticosteroids, IVIG, plasma exchange) and tumor removal often result in significant improvement. Second-line therapies (rituximab, cyclophosphamide) are beneficial in refractory cases. Early treatment, ideally within four weeks of symptom onset, is associated with better outcomes. Emerging therapies such as tocilizumab and bortezomib show promise but require further validation. Conclusions. Anti-NMDAR encephalitis is a treatable autoimmune condition with variable outcomes depending on diagnostic timing and treatment initiation. Early recognition and prompt immunotherapy are critical, often beginning before antibody confirmation. Multidisciplinary care and long-term rehabilitation are often necessary. While clinical outcomes have improved, high-quality randomized trials are needed to optimize treatment strategies and guide personalized care.
Iordache et al. (Mon,) studied this question.