Abstract
Studies show that psychiatric symptoms in adults and children are sometimes associated with serum neural autoantibodies. The significance of serum neural autoantibodies associated with psychiatric symptoms in children remains often unclear, but might be relevant for the extent and occurrence of psychiatric disease manifestation in later life, as well as therapy and outcome. For this narrative review, we sought articles listed in PubMed and published between 1988 and 2020 addressing the maternal–fetal transfer of neural autoantibodies and psychiatric disorders associated with serum neural autoantibodies. We identified six major subgroups of psychiatric disorders in children that are associated with serum neural autoantibodies: patients with attentional deficit hyperactivity disorder, autism spectrum disorder, obsessive compulsive disorder, Gilles de la Tourette syndrome, psychosis and catatonia. Furthermore, we summarized study findings from maternal–fetal transfer of Contactin-associated protein-like 2, N-methyl-d-aspartate receptor and fetal brain autoantibodies associated with behavioral effects in animals and humans. We hypothesize that the maternal transfer of serum neuronal autoantibodies during or after birth could result (1) in the ignition of an autoimmune-mediated inflammation having neurodevelopmental consequences for their children (autoimmune-priming-attack hypothesis) and (2) has a potential impact on the later manifestation of psychiatric disorders. Through this narrative review, we propose a diagnostic pathway for the clinical diagnosis of a potentially autoimmune origin of psychiatric symptoms in children while considering recent guidelines.
Highlights
Autoimmune-mediated encephalitis in children manifests with an acute or subacute neuropsychiatric syndrome concomitant with paraclinical findings and/or underlying neuronal autoantibodies lasting less than three months (Cellucci et al 2020)
Pediatric autoimmune encephalitis should be distinguished from the clinical diagnosis of PANS, which is characterized by an abrupt onset of obsessive compulsive disorder (OCD) or heavily restricted food intake and more than two additional symptoms in terms of anxiety, aggression, behavioral, sensory or motor abnormalities or sleep dysfunction
We reported relevant studies showing an association between serum or cerebrospinal fluid (CSF) autoantibodies and reported psychiatric disorders [psychosis, catatonia, Tourette syndrome (TS), Attention-deficit hyperactivity disorder (ADHD), OCD, autism spectrum disorder (ASD)] in our narrative review below
Summary
Autoimmune-mediated encephalitis in children manifests with an acute or subacute neuropsychiatric syndrome concomitant with paraclinical findings and/or underlying neuronal autoantibodies lasting less than three months (Cellucci et al 2020). Pediatric autoimmune encephalitis should be distinguished from the clinical diagnosis of PANS (pediatric acute-onset neuropsychiatric syndrome) (for differential diagnosis, Fig. 1), which is characterized by an abrupt onset of obsessive compulsive disorder (OCD) or heavily restricted food intake and more than two additional symptoms in terms of anxiety, aggression, behavioral, sensory or motor abnormalities or sleep dysfunction (for review, see Murphy et al 2014). Besides these pediatric syndromes, psychiatric symptomatology may be due to an autoimmune process without obvious organic symptoms or paraclinical findings derived from the criteria for autoimmune encephalitis according to Cellucci et al (2020). We reported relevant studies showing an association between serum or cerebrospinal fluid (CSF) autoantibodies and reported psychiatric disorders [psychosis, catatonia, TS, ADHD, OCD, autism spectrum disorder (ASD)] in our narrative review below
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