Clinical Sciences/Health Conditions
Sangita Kuparasundram, MBBS, MMed (Int Med), MRCP (UK), FAMS
Consultant, Department of Rehabilitation Medicine
Singapore General Hospital
Singapore, Singapore
Wai Dic Foong, MD, MMed (Int Med), MRCP (UK)
Associate Consultant, Department of Neurology
National Neuroscience Institute (Singapore General Hospital Campus)
Singapore, Singapore
Tih Shih Lee, MD, Board Cert (Psych), FAMS (Psych), PhD, FRCPSC, FRCPEd
Professor, Duke-NUS & Senior Consultant, Department of Psychiatry
Singapore General Hospital
Singapore, Singapore
A 25-year-old Asian female nurse with no prior medical or psychiatric history presented with new-onset seizures. She was diagnosed with anti-NMDA receptor encephalitis based on positive blood serum and cerebrospinal fluid samples. Her illness was characterised by significant cognitive deficits with prominent mood and behavioural disturbances. Through coordinated interdisciplinary care and comprehensive rehabilitation, she achieved good functional recovery and is in the process of returning to work. This poster outlines her clinical course and recovery trajectory across both inpatient and outpatient settings.
Discussions:
This patient was hospitalised for 13 weeks in 2024, including 2 weeks of intensive rehabilitation. She received treatment for NMDA-receptor encephalitis and seizures as directed by Neurology. Psychiatry optimised pharmacological management of episodes of agitation, intermixed with catatonic features, which subsequently evolved to irritability and anxiety.
Cognitive deficits were noted on Montreal Cognitive Assessment (MOCA, score: 27/30) with slow processing speed. She had intermittent dyskinesias but no other significant neurological impairments. Early rehabilitation targeted orientation, mobility, and basic Activities of Daily Living (ADLs), progressing to higher-level functional retraining. On discharge from hospital, she required assistance in management of finances and medications but was otherwise independent.
At outpatient follow up, she demonstrated continued functional progress and a graded return to work plan was implemented with vocational support. Despite a favourable trajectory, she reported reduced cognitive self-efficacy and anxiety regarding her work performance which prompted further medication adjustment.
Conclusions:
This case illustrates the importance of interdisciplinary collaboration- spanning Rehabilitation Medicine, Neurology, and Psychiatry- in managing the multifaceted recovery challenges of anti-NMDA receptor encephalitis. Beyond medical stabilisation, individualised and targeted strategies are important to facilitate rehabilitation and maximise functional recovery with aims of reintegration into work and community life.
