Clinical characteristics and pathogen screening of 38 children with anti-N-methyl-D-aspartate receptor encephalitis

Abstract

Objective To analyze the clinical characteristics and screen pathogens and prognosis of anti-N-methyl-D-aspartate receptor(NMDAR) encephalitis in children and so as to improve the diagnosis and treatment of anti-NMDAR encephalitis in children. Methods A retrospective and follow-up analysis of 38 cases of pediatric anti-NMDAR encephalitis was performed, who were admitted to the West China Second University Hospital, Sichuan University from May 2012 to June 2016, and their clinical features, associated pathogen screening, treatment and prognosis were reviewed. Results Those 38 cases included 14 males and 24 females.The age ranged from 1 year and 10 months to 17 years and 6 months.The most common symptoms were psychiatric symptoms (33 cases), and dyskinesias and movement disorders (33 cases), speech disturbances (31 cases). Twenty-four cases (63.2%) received positive pathogenic screening and only one case had right ovarian mature cystic teratoma.Among them, 11 cases had positive mycoplasma pneumonia immunoglobulin M(IgM) antibodies, 10 cases had positive virus screening, and 1 case had toxoplasma gondii IgM antibodies positive, and 2 cases had mix infection.Symptoms of one case were relieved after anti-toxoplasma treatment without immunosuppression treatment, and another case had partial symptom relief after mycoplasma pneumonia treatment.Thirty-seven cases received immunosuppressant therapy(4 cases were treated with glucocorticoid, 12 cases were treated with glucocorticoid combined with immune globulin, 2 cases were treated with glucocorticoid combined with plasma exchange, still 19 cases were treated with glucocorticoid combined with immune globulin and plasma exchange). After follow-up for median 12 months, 3 cases relapsed, 29 cases were fully recovered, 5 cases had mild language impairment, 2 cases had mild memory impairment, and 2 cases had involuntary movement. Conclusions The most common symptoms of the patients were psychiatric symptoms, dyskinesias and movement disorders, and speech disturbances.Children with anti-NMDAR encephalitis had a low incidence of tumors, while various pathogen infections including mycoplasma pneumonia, virus and toxoplasma gondii, which may trigger abnormal immune response of anti-NMDAR encephalitis.Pathogen screening needs to be done for pediatric anti-NMDAR encephalitis and anti-pathogenic treatment may be helpful for disease remission. Key words: Anti-N-methyl-D-aspartate receptor encephalitis; Pathogen; Child