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"N-methyl-D-aspartate (NMDA) receptor encephalitis stands as the most common form of autoimmune encephalitis in young adults, characterized by a spectrum of distressing symptoms such as seizures, behavioral disruptions, autonomic dysfunction, and memory impairment. We present a noteworthy case involving a young adult male exhibiting seizures and renal failure, initially prompting an evaluation for vasculitis, hyperuricemia-induced acute kidney injury (AKI), and rhabdomyolysis-induced AKI. However, subsequent findings revealed the presence of NMDA receptor antibodies, and a renal biopsy confirmed tubulointerstitial nephritis. This case sheds light on the association between renal failure and NMDA receptor antibody-associated encephalitis, marking a rare instance in our knowledge."

"Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is a rare autoimmune demyelinating disorder of the central nervous system that can present with varied neurological symptoms. While commonly mistaken for multiple sclerosis or neuromyelitis optica spectrum disorders, MOGAD can also mimic cerebrovascular events, posing a diagnostic challenge. We report a case of a 30-year-old male who initially presented with acute-onset left-sided hemiplegia and right facial palsy, raising suspicion of an ischemic stroke. Despite thrombolysis, his recurrent neurological symptoms, including dysarthria and cerebellar ataxia, prompted further evaluation. Neuroimaging revealed hyperintense lesions in the right hemi-pons and bilateral middle cerebellar peduncles, raising the possibility of a demyelinating disorder. MOG-IgG seropositivity confirmed the diagnosis of MOG encephalitis. The patient responded well to pulse corticosteroid therapy, followed by maintenance immunosuppression with mycophenolate mofetil, and remained asymptomatic on follow-up. This case underscores the importance of considering autoimmune demyelinating disorders in young patients with recurrent neurological deficits and clinico-radiological dissociation. Early recognition and appropriate immunotherapy can prevent unnecessary thrombolysis and improve patient outcomes. Clinicians should maintain a high index of suspicion for MOGAD as a potential stroke mimic in atypical presentations."

"In children with epilepsy associated with global developmental delay (GDD), around 10–20% experience refractory epilepsy, often requiring multiple antiseizure drugs (ASDs). These ASDs have narrow therapeutic indices. Therapeutic drug monitoring is crucial for optimizing ASD therapy. In this case, an infant with GDD with TBC1D24 mutation and refractory seizures was admitted with uncontrolled seizures despite multiple ASDs. The patient’s serum levels of valproic acid, carbamazepine, and phenytoin were subtherapeutic. Simulations were performed by solving the pharmacokinetic ordinary differential equations numerically to optimize the dose. The modifications were made for valproate (240 mg every 4 h) and carbamazepine (100 mg thrice a day) to achieve therapeutic concentrations. Serum drug levels, after dose adjustment, were within the therapeutic range. The patient experienced no further seizure episodes. This case highlights the importance of individualized pharmacokinetic simulation in optimizing drug doses instead of empirical dose adjustments."

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