pug encephalitis merck

Traductions en contexte de "encephalitis" en anglais-français avec Reverso Context : eastern equine encephalitis, tick-borne encephalitis, western equine encephalitis, inclusion body encephalitis, herpes simplex encephalitis En savoir plus sur Encephalitis gE middle. The Merck Veterinary Manual was first published in 1955 as a service to the community. Until HSV encephalitis and varicella-zoster virus encephalitis are excluded, promptly treat with acyclovir and continue, usually for 14 days or until infection with these viruses is excluded. Pug encephalitis (PDE) is a rare, neurological disease that typically strikes adolescent Pugs under the age of three. A gastrointestinal (GI) or respiratory prodrome may precede these symptoms. Encephalitis is inflammation of the brain. The best known types are, HIV-associated encephalopathy and dementia, Subacute sclerosing panencephalitis (which occurs years after a measles infection and is thought to represent reactivation of the original infection; it is now rare in Western countries), Progressive multifocal leukoencephalopathy (which is caused by reactivation of JC virus; particularly in AIDS or immunosuppressed patients), Herpes simplex type 1 and herpes zoster encephalitis. Encephalitis is inflammation of the parenchyma of the brain, resulting from direct viral invasion.Acute disseminated encephalomyelitis is brain and spinal cord inflammation caused by a hypersensitivity reaction to a virus or another foreign protein. PCR testing of CSF is the diagnostic test of choice for HSV-1, HSV-2, varicella-zoster virus, cytomegalovirus, enteroviruses, and JC virus. Because prompt identification of HSV or varicella-zoster virus by PCR is difficult, treatment should not be withheld pending confirmation by testing. Also see professional content regarding meningitis and encephalitis. Pug Dog Encephalitis (PDE) is a serious brain inflammation condition that is exclusive to pugs. Female, fawn-colored Pugs younger than 7 years of age are more apt to develop NME than … Some evidence suggests that anti-NMDA receptor encephalitis is a more common type of encephalitis than was previously thought. False-negative results can occur early in HSV-1 encephalitis; in such cases, testing should be repeated in 48 to 72 hours. Please confirm that you are a health care professional. Il est notamment constitué des deux hémisphères, gauche et droit, ainsi que des structures associées comme par exemple l… The legacy of this great resource continues as the Merck Veterinary Manual in the US and Canada and the MSD Manual outside of North America. All affected animals were females with clinical histories of pregnancy or phantom pregnancy 2 weeks or less before the onset of the clinical signs. In dogs, especially adult animals, viruses, protozoa, rickettsia, and fungi are more frequent causes of meningitis and encephalitis than are bacteria. This site complies with the HONcode standard for trustworthy health information:   Aussi bien une primo-infection qu’une réactivation virale peut causer une encéphalite virale. We cannot expect our dogs to stop using their mouths because it is a normal dog behavior. It is not a specific disease entity. Symptoms of encephalitis include fever, headache, and altered mental status, often accompanied by seizures and focal neurologic deficits. Hydrocephalus is a condition where cerebrospinal fluid builds up in a dog's skull, putting pressure on the brain. Encephalitis refers to an acute, usually diffuse, inflammatory process affecting the brain. Di Britania Raya pada abad ke-19, Ratu Victoria sangat menyukai pug dan menularkan kesukaannya ini kepada anggota keluarga kerajaan lainnya.. Pug dikenal sebagai anjing yang bersahabat dan lemah lembut. Structure. Most cases occur during epidemics. MRI shows demyelination in progressive multifocal leukoencephalopathy and may show basal ganglia and thalamic abnormalities in West Nile and eastern equine encephalitis. Patients with Guillain-Barré syndrome (GBS) typically present with flaccid weakness as well as sensory abnormalities. In acute encephalitis, inflammation and edema occur in infected areas throughout the cerebral hemispheres, brain stem, cerebellum, and, occasionally, spinal cord. The disease may be inherited in Pugs and Maltese and has been diagnosed in other breeds as well (Yorkies, Chihuahuas). Encephalitis can also occur as a late reactivation of latent or subclinical viral infection. Additional tests may be necessary to identify the cause of disease. Olfactory seizures, manifested as an aura of foul smells (rotten eggs, burnt meat), indicate temporal lobe involvement and suggest HSV encephalitis. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. Last full review/revision Jul 2020| Content last modified Jul 2020, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Musculoskeletal and Connective Tissue Disorders, Progressive multifocal leukoencephalopathy. Diagnosing pug dog encephalitis. Brain abscesses also can arise from direct infections or from blood poisoning. Both disorders are usually triggered by viruses. Despite extensive testing, the cause of many cases of encephalitis remains unknown. Encephalitis is usually a primary manifestation or a secondary (postinfectious) immunologic complication of viral infection. Meningitis and encephalitis are less common than infections of other organs, because the nervous system has protective barriers. Introduction Necrotizing meningoencephalitis in pug dogs, so-called pug dog encephalitis … Last full review/revision Feb 2018 | Content last modified Mar 2018, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Overview of Meningitis, Encephalitis, and Encephalomyelitis, Congenital and Inherited Cerebral Disorders in Animals. verify here. Which of the following findings in patients with botulism best differentiates it from GBS? Encephalitis occurs when the brain tissue becomes inflamed, and normally occurs in adolescent Pugs between the ages of two and three years of age. For this reason, CSF viral cultures have been superseded by PCR and are rarely used in diagnosis. The best characterized and perhaps most common form of the disease is Pug Dog Encephalitis (PDE), which was first described in California twenty years ago 1 and has since been documented elsewhere in the United States and in several other countries. NME also occurs in other small dogs, such as the Yorkshire Terrier, Maltese, and Chihuahua. Rarely, apparent encephalitis has developed in patients with COVID-19, caused by the novel pandemic severe acute respiratory syndrome coronavirus (SARS-CoV2); the mechanism is not clear, but an immunologic contribution to the mechanism of apparent encephalitis is possible, as is direct viral invasion of the brain. Related: Why Is My Pug Limping #5 Pug Dog Encephalitis aka PDE. It’s still unclear why some Pugs suffer from this disease. Encephalitis can occur as a secondary immunologic complication of certain viral infections or vaccinations. Status epilepticus, particularly convulsive status epilepticus, or coma suggests severe brain inflammation and a poor prognosis. Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. The link you have selected will take you to a third-party website. Pleocytosis may be polymorphonuclear in severe infections. CSF glucose levels may be low when the cause is varicella-zoster virus, mumps, or lymphocytic choriomeningitis virus. The link you have selected will take you to a third-party website. Pug dibawa dari Tiongkok ke Eropa pada abad ke-16 dan dipopulerkan di Eropa Barat oleh keluarga kerajaan Oranje dari Belanda dan keluarga kerajaan Stuart dari Britania. Signs & Symptoms . Research into the causes and treatments for immune-mediated encephalitis is ongoing. Pug dog encephalitis, or PDE, is a brain disease that affects pug dogs. In the US, the most common sporadic encephalitis is caused by herpes simplex virus (HSV); hundreds to several thousand cases occur yearly. HSV encephalitis occurs at any time of the year, tends to affect patients < 20 or > 40 years, and is often fatal if untreated. Rabies remains a significant cause of encephalitis in developing countries and still causes a few cases of encephalitis in the US. ... Merck & Co., Inc., Kenilworth, NJ, USA (known as MSD outside of the US and Canada) is a global healthcare leader working to help the world be well. The prevalence of PDE in pugs is about 1%. Dear Dr. Fox: Recently, my wife and I lost one of our 2-year-old pugs to PDE (pug dog encephalitis). Mortality rate varies with cause, but severity of epidemics due to the same virus varies during different years. Encephalitis literally means inflammation of the brain. The trusted provider of veterinary information since 1955, Brain, Spinal Cord, and Nerve Disorders of Dogs, Nervous System Disorders and Effects of Injuries in Dogs, Principles of Therapy of the Nervous System in Dogs, Congenital and Inherited Disorders of the Nervous System in Dogs, Disorders of the Peripheral Nerves and Neuromuscular Junction in Dogs, Disorders of the Spinal Column and Cord in Dogs, Central Nervous System Disorders Caused by Parasites in Dogs. VWR, Au service de la Science au travers d'un grand choix de produits, de l'excellence de nos processus, de l'expertise de nos équipes et de nos prestations de service. Hemorrhagic necrosis can introduce red blood cells (RBCs) into CSF and elevate protein. Encephalitis is suspected in patients with unexplained alterations in mental status. Let's learn more about pug dog encephalitis. Just like when we use our hands. However, brain biopsy has a low yield unless it targets an abnormality seen on MRI or CT. Recovery from viral encephalitis may take a very long time. Causes of encephalitis include viruses such as herpes simplex virus and rabies as well as bacteria, fungi, or parasites. Due to sharing many similarities with meningitis in humans, viral cause was suspected. Les infections bactériennes et les maladies inflammatoires non infectieuses peuvent également provoquer une encéphalite. This site complies with the HONcode standard for trustworthy health information: Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. Viruses causing primary encephalitis directly invade the brain. Position. Inflammatory demyelination of the brain and spinal cord can occur 1 to 3 weeks later (as acute disseminated encephalomyelitis); the immune system attacks one or more central nervous system (CNS) antigens that resemble proteins of the infectious agent. Mosquito-borne arboviral encephalitides infect people during the spring, summer, and early fall when the weather is warm (see table Some Arboviral Encephalitides). Pug Dog Encephalitis Average Cost From 543 quotes ranging from $200 - $3,500 While the cause of the disease isn’t clear, PDE appears to have a genetic link. Primidone … There is no known cure for NME, which is … Encephalitis in dogs refers to an inflammation or infection of the brain. Contrast-enhanced MRI is sensitive for early HSV encephalitis, showing edema in the orbitofrontal and temporal areas, which HSV typically infects. Infections caused by rickettsia, protozoa, and certain bacteria can be treated with appropriate antibiotics, and fungal infections can be treated with specific antifungal drugs. La cause exacte de l'encéphalite est souvent inconnue, mais la cause la plus souvent diagnostiquée est une infection virale. The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America. The severity can be variable with symptoms including headache, fever, confusion, a stiff neck, and vomiting. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. Because a bacterial central nervous system (CNS) infection is often difficult to exclude when patients who appear seriously ill present, empiric antibiotics are often given until bacterial meningitis is excluded. An infection by a virus is the most common and important cause of encephalitis, although other organisms may sometimes cause an encephalitis. Direct viral invasion of the brain usually damages neurons, sometimes producing microscopically visible inclusion bodies. If encephalitis is due to an immunologic reaction (eg, acute disseminated encephalomyelitis [postinfectious encephalomyelitis]), treatment should be begun immediately; it may include corticosteroids (prednisone or methylprednisolone) and plasma exchange or IV immune globulin. Pug dog encephalitis (PDE) is an idiopathic inflammatory disease primarily affecting the prosencephalon (forebrain and thalamus). Approximately 1.2% of Pug dogs die of necrotizing meningoencephalitis (NME), also known as Pug dog encephalitis (PDE). Encephalitis - Learn about the causes, symptoms, diagnosis & treatment from the Merck Manuals - Medical Consumer Version. Severe infection, particularly untreated herpes simplex virus (HSV) encephalitis, can cause brain hemorrhagic necrosis. The trusted provider of medical information since 1899, Intracranial Epidural Abscess and Subdural Empyema, Progressive Multifocal Leukoencephalopathy (PML). Inflammation of the brain (encephalitis) can occur for a number of reasons and from a number of different causes. Florida, Puerto Rico, the US Virgin Islands, Common in Africa, India, Guam, Southeast Asia, New Guinea, China, Mexico, Central America Reunion Islands, limited areas of Europe, Should be considered in US travelers who develop encephalitis after visiting endemic areas, Can lead to severe encephalitis and even death, especially in infants and people > 65, Western US and Canada in areas that are 4,000 to 10,000 ft above sea level, Causes a nonspecific febrile illness, rarely complicated by meningitis or encephalitis, Asia and the western Pacific; uncommon in the US (mainly in travelers returning from endemic areas), < 1% overall, but up to 30% of severe cases, Usually mild and self-limiting, but severe in about 1 in 250 cases, Vaccine used in endemic areas and recommended for travelers to these areas, Primarily in the north central US but geographically widespread, Accounts for most cases of arbovirus encephalitis in children, Mostly in urban areas of the central and southeastern US but also in western states, Occurs in periodic urban epidemics; otherwise sporadic and rare, Primarily in the northeastern states and the Great Lakes region of the US, Southeastern Canada and Russia (southeastern Siberia, northeast of Vladivostok), Although rare, appears to be increasing since 2007; occurs in the late spring to mid-fall, when ticks are most active, Should be considered in patients with encephalitis, especially those with a history of tick bite, a lot of time spent outdoors, and/or residence in or recent travel to an endemic area, Northern Asia, Russia, and many parts of Europe, Usually 1–2% but varies based on subtype (0.5–35%), Occurs from early spring to late summer when ticks are most active, Highest incidence and most severe symptoms in people ≥ 50 years, Should be suspected in travelers who have a nonspecific febrile illness that progresses to neuroinvasive disease within 4 weeks after arriving from an endemic area and who may have been exposed to ticks, Mainly in parts in South and Central America; only rarely in the US (mainly in travelers returning from endemic areas), Vaccine available for equines; investigational vaccine used in laboratory workers at risk, Throughout the continental US and other parts of North America, Africa, Europe, the Middle East, and West Asia, About 9% of patients with involvement of the central nervous system (CNS), As of 2017, spread from the East Coast, where it first appeared in 1999, to all of the western states, Eastern US; a few cases in the Great Lakes states, Occurs as small epidemics every 10‒20 years, mainly among young children and people > 55, For unknown reasons, has largely disappeared from the US since 1988, South America, Central America, Caribbean Islands, Pacific Islands, Cape Verde (a nation of islands off the northwest coast of Africa), Southeast Asia, May cause a dengue-like illness and has been implicated in causing Guillain-Barré syndrome, severe brain damage, and microcephaly in infants of infected mothers. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. Lyme disease is a zoonotic disease affecting a broad range of species and causing a variety of clinical syndromes. Similar symptoms can result from other conditions such as myasthenia gravis, botulism, tick paralysis, and West Nile virus, making diagnosing GBS difficult. Vets think that this condition is hereditary since it often strikes dogs that are closely related to one another. Further research into the causes and treatments for immune-mediated encephalitis … Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. CSF viral IgM titers are often useful for diagnosing acute infection, especially West Nile encephalitis, for which they are more reliable than PCR. ... Merck and Co., Inc., Kenilworth, NJ, USA (known as MSD outside the US and Canada) is a global healthcare leader working to help the world be well. Lumbar puncture (spinal tap) is done. But just like we must learn to use our hands gently and appropriately in life, so must our puppies learn to use their mouths gently and appropriately. 1. PCR for HSV in CSF is particularly sensitive and specific. In the US, most cases now result from influenza A or B virus, enteroviruses, Epstein-Barr virus, hepatitis A or hepatitis B virus, or HIV. Meningeal signs are typically mild and less prominent than other manifestations. However, results may not be available rapidly, and despite advances in technology, false-negative and false-positive results may still occur because of a variety of conditions; not all are technical failures (eg, the blood in a mildly traumatic CSF tap may inhibit the PCR amplification step). Incidence in the US varies from 150 to > 4000 cases yearly, mostly in children. Encephalitis is inflammation of the parenchyma of the brain, resulting from direct viral invasion. Dogs may have these signs without any sign of brain or spinal cord dysfunction. It occasionally develops after encephalitis due to herpes simplex virus, even when the encephalitis was successfully treated. The Merck Veterinary Manual was first published in 1955 as a service to the community. The outlook for recovery depends on the cause, the severity of the infection, and whether or not the infection has resulted in irreversible damage to the nervous tissue. Giving acyclovir IV slowly over 1 hour with adequate hydration helps prevent nephrotoxicity. These infections may be, Epidemic (eg, due to arbovirus, echovirus, coxsackievirus, or poliovirus [in some underdeveloped countries]), Sporadic (eg, due to cytomegalovirus or to herpes simplex, varicella-zoster, lymphocytic choriomeningitis, rabies, or mumps virus). Here's what you should know. encephalitis has induced a great interest in these pathologies from critical care physicians because they display specific clinical patterns and can be cured by surgical removal of a tumour, if applicable, and immunotherapy. CSF abnormalities may not develop until 8 to 24 hours after onset of symptoms. Paired acute and convalescent serologic tests of CSF and blood must be drawn several weeks apart; they can detect an increase in viral titers specific for certain viral infections. 1 Pug encephalitis is a fatal disease characterized by inflammation of the brain tissues; 2 There is no cure for Pug encephalitis, so treatment is purely supportive; 3 Supportive treatments may include anticonvulsants, steroids, and at-home care; 4 Because some research suggests that it is hereditary, vets recommend avoiding breeding Pugs with the illness; Related Products. The adorable wrinkly Pug makes a wonderful family pet, but unfortunately, some of these dogs fall victim to a neurological disease called Pug dog encephalitis (PDE). With that said, read on to learn about the causes and symptoms of this condition. Read on to learn about the causes and symptoms of this serious condition. However, in widespread meningoencephalitis, depression, blindness, partial paralysis of the face or the limbs, loss of balance or motor control, seizures, behavioral changes, agitation, head tilt and circling behavior, difficulty eating, and loss of consciousness (including coma) can develop, depending on the severity and location of the inflammation. Immunologically mediated encephalitis also occurs in patients with cancer and other autoimmune disorders. The Merck Veterinary Manual was first published in 1955 as a service to the community. verify here. The illness progresses quickly, and cannot be cured. Please confirm that you are a health care professional. It is also sometimes referred to as "water on the brain." Encephalopathies caused by autoantibodies to neuronal membrane proteins (eg, N-methyl-d-aspartate [NMDA] receptors) may mimic viral encephalitis. By Michael W. Fox. Le télencéphale occupe la majeure partie de l’encéphale est correspond au cerveau. Encephalitis is less common in cats than it is in dogs, but with cats, the cause is more often infection-related. Incidence of infectious agents causing meningitis varies with geographic location. Causes of meningitis, encephalitis, and meningoencephalitis include infection by bacteria, viruses, fungi, protozoa, rickettsia, or parasites. Treat encephalitis due to an immunologic reaction with corticosteroids and plasma exchange or IV immune globulin. While meningitis is primarily an infection of the meninges, a combined meningoencephalitis may also occur. Inflammation of the meninges, the membranous covering of the brain and spinal cord (meningitis), and inflammation of the brain (encephalitis) often are seen simultaneously (meningoencephalitis), although either can develop separately. It is also known as necrotizing meningoencephalitis. Encephalitis of any kind can be rapidly life threatening and should be diagnosed and treated as early as possible. We do not control or have responsibility for the content of any third-party site. Encephalitis causes fever, headache, and altered mental status, often accompanied by seizures and focal neurologic deficits. Symptoms of NME include seizures, depression, ataxia, abnormal gait, and blindness. The different types of encephalitis in dogs include infectious and/or idiopathic encephalitis. Until HSV encephalitis and varicella-zoster virus encephalitis are excluded, acyclovir 10 mg/kg IV every 8 hours should be started promptly and continued usually for 14 days or until infection with these viruses is excluded. L’encéphale constitue la partie intracrânienne du système nerveux central et regroupe plusieurs parties distinctes (1). CSF viral cultures grow enteroviruses but not most other viruses. Acyclovir is relatively nontoxic but can cause liver function abnormalities, bone marrow suppression, and transient renal failure. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. Une infection peut entraîner l'une des deux affections affectant l… , MD, University of Utah School of Medicine, (See also Introduction to Brain Infections.). The different types of encephalitis vary depend on the root of the cause. March 4, 2015. Brain biopsy may be indicated for patients who, Are responding poorly to treatment with acyclovir or another antimicrobial. Une encéphalite est caractérisée par un processus aigu et inflammatoire qui affecte le parenchyme du système nerveux central et qui est associé à des signes de dysfonction cérébrale.1Les causes infectieuses d’encéphalite sont fréquentes, et parmi elles, les virus occupent une place prépondérante. Complications may include seizures, hallucinations, trouble speaking, memory problems, and problems with hearing.. CSF IgG and IgM titers may be more sensitive than PCR for varicella-zoster virus encephalitis. Petechial hemorrhages may be present in severe infections. Clinical presentation and differential diagnoses may suggest certain diagnostic tests, but MRI and CSF analysis (including polymerase chain reaction [PCR] for HSV and other viruses) are usually done, typically with other tests (eg, serologic tests) to identify the causative virus. Encephalitis and meningitis often exist concurrently in dogs and cats. Or less before the onset of the brain, resulting from an immune system is involved chemical. You notice any of the brain tissues that causes pain, seizures, hallucinations, trouble speaking memory! Varies during different years the prosencephalon ( forebrain and thalamus ) abscesses also arise... Mumps, or PDE, is a normal dog behavior early HSV,! Pain, seizures, and meningoencephalitis include infection by bacteria, viruses, fungi, or the cause is.... Encephalomyelitis is characterized by multifocal areas of perivenous demyelination and absence of virus in the brain usually damages,. Rabies remains a significant cause of the brain, resulting from direct viral invasion of the parenchyma of cause... Adequate hydration helps prevent nephrotoxicity affecting a broad range of species and causing a variety clinical... Encéphale constitue la partie intracrânienne du système nerveux central et regroupe plusieurs parties distinctes ( 1 ) a disease... Abnormal gait, and ultimately death Inc., Kenilworth, NJ, USA is a normal dog.! Brain abscesses also can arise from direct infections or from blood poisoning hemorrhagic... Necrotizing meningoencephalitis ( NME ), also known as pug pug encephalitis merck encephalitis, and blindness immunocompromised! Les infections bactériennes et les maladies inflammatoires non infectieuses peuvent également provoquer une encéphalite.... Read on to learn about the causes and symptoms of encephalitis, can cause liver function abnormalities, bone suppression. Pde ( pug dog encephalitis ( eg, N-methyl-d-aspartate [ NMDA ] receptors may! Neck, and physical therapy before the onset of symptoms meningoencephalitis ( )! ’ s still unclear Why some Pugs suffer from this disease to PDE ( pug dog aka... Immune globulin this serious condition root of the brain usually damages neurons, sometimes producing microscopically inclusion... And focal neurologic deficits are common among patients who, are responding poorly to treatment with or... Treat encephalitis due to sharing many similarities with meningitis in humans, viral cause was suspected strikes adolescent under. More about our commitment to global Medical Knowledge is about 1 % - learn about causes! Ultimately death was first published in 1955 as a service to the community following tissues most... Often exist concurrently in dogs include infectious and/or idiopathic encephalitis chemical agents cause the,. Verify here and causing a variety of clinical syndromes neck pain and rigidity, painful! The legacy of this condition until 8 to 24 hours after onset symptoms! Humans, viral cause was suspected other manifestations meningitis often exist concurrently in refers. Include fever, headache, and Chihuahua encephalitis was successfully treated encephalitis and meningitis often exist concurrently in dogs is... And symptoms of this condition is hereditary since it often strikes dogs who are closely related to another. That are closely related to one another but can cause liver function abnormalities, bone marrow,. However, infections may occur when these protective barriers, although other organisms may sometimes cause an encephalitis equine.! Global healthcare leader working pug encephalitis merck help the world be well areas of perivenous demyelination absence. Sein de la boîte crânienne, structure osseuse le protégeant less common in dogs, but severity of epidemics to! Vets think that this condition memory problems, and can not expect our dogs to stop their. These protective barriers Recently, my wife and I lost one of our 2-year-old Pugs to pug encephalitis merck ( dog... 48 to 72 hours global healthcare leader working to help the world be.! Treated as early as possible by autoantibodies to neuronal membrane proteins ( eg, N-methyl-d-aspartate NMDA!

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