Herpes simplex virus encephalitis is a trigger of brain autoimmunity

Thaís Armangue, Frank Leypoldt, Ignacio Málaga, Miquel Raspall-Chaure, Itxaso Marti, Charles Nichter, John Pugh, Monica Vicente-Rasoamalala, Miguel Lafuente-Hidalgo, Alfons MacAya, Michael Ke, Maarten J. Titulaer, Romana Höftberger, Heather Sheriff, Carol Glaser, Josep Dalmau

Research output: Contribution to journalArticleResearchpeer-review

361 Citations (Scopus)


In 5 prospectively diagnosed patients with relapsing post-herpes simplex encephalitis (HSE), N-methyl-D-aspartate receptor (NMDAR) antibodies were identified. Antibody synthesis started 1 to 4 weeks after HSE, preceding the neurological relapse. Three of 5 patients improved postimmunotherapy, 1 spontaneously, and 1 has started to improve. Two additional patients with NMDAR antibodies, 9 with unknown neuronal surface antibodies, and 1 with NMDAR and unknown antibodies, were identified during retrospective assessment of 34 HSE patients; the frequency of autoantibodies increased over time (serum, p = 0.004; cerebrospinal fluid, p = 0.04). The 3 retrospectively identified NMDAR antibody-positive patients also had evidence of relapsing post-HSE. Overall, these findings indicate that HSE triggers NMDAR antibodies and potentially other brain autoimmunity. © 2014 American Neurological Association.
Original languageEnglish
Pages (from-to)317-323
JournalAnnals of Neurology
Issue number2
Publication statusPublished - 1 Jan 2014


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