Diagnostic Challenges in Pediatric Anti-NMDA Receptor Encephalitis (P5-5.011)

Abstract

<h3>Objective:</h3> To describe the progression of symptoms, diagnostic testing, and encounters with the health care system that pediatric patients experience prior to receiving a confirmed diagnosis of anti-NMDAR encephalitis. <h3>Background:</h3> Prompt treatment of anti-NMDAR encephalitis in pediatric patients is associated with improved outcomes, but diagnosis remains challenging. Heterogeneity in presentations, variability based on age, and broad differential diagnoses of associated symptoms in the pediatric population can complicate timely and accurate identification of the disease. <h3>Design/Methods:</h3> A retrospective chart review for patients within Primary Children’s Hospital (PCH) was conducted. ICD10 code G04.81 at PCH between January 2007 to September 2022 was queried to identify pediatric patients with “other encephalitis”. Of these 147 pediatric patients, 18 had confirmed anti-NMDAR encephalitis based on clinical features and positive NMDAR Ig antibody testing in the cerebrospinal fluid <h3>Results:</h3> We identify a cohort of pediatric patients with confirmed anti-NMDAR encephalitis, and discuss duration and progression of symptoms, diagnostic testing, interventions, number of encounters within the health care system, and involved subspecialties prior to a final diagnosis being made. We also review characteristics associated with prolonged times to diagnosis. <h3>Conclusions:</h3> Pediatric patients with anti-NMDAR encephalitis often have an evolution of symptoms, extensive diagnostic evaluations, and multiple encounters with the healthcare system prior to confirmation of diagnosis. Factors associated with prolonged time until diagnosis may aid in identifying those at risk for diagnostic delays. Additionally, recognition of the path to diagnosis these children often take may help physicians better understand the challenges and stressors patients and families face, not only following a diagnosis of anti-NMDAR encephalitis, but also leading up to it. <b>Disclosure:</b> Dr. Wright has nothing to disclose. The institution of an immediate family member of Dr. Liu has received research support from NIH. Mr. Wong has nothing to disclose. Dr. Noroozi Gilandehi has nothing to disclose. Miss Shapiro has nothing to disclose. Dr. Smith has nothing to disclose. The institution of Dr. Peterson has received research support from Kronus. Dr. Clardy has received personal compensation for serving as an employee of Veterans Health Administration (VHA). Dr. Clardy has received personal compensation for serving as an employee of University of Utah Health. Dr. Clardy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology/AAN Publications. The institution of Dr. Clardy has received research support from Sumaira Foundation for NMO. The institution of Dr. Clardy has received research support from Western Institute for Veteran Research. The institution of Dr. Clardy has received research support from NIH/NINDS. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a AAN Summer Meeting CoDirector Travel and Lodging with AAN. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Travel and Lodging with U of Iowa. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Speaker Honoraria for Grand Rounds with Barrow Neurological Institute. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Speaker Honoraria for Grand Rounds with Beaumont Health.