P58 – 2384: Neuropsychological outcomes at disease onset and one year follow-up in a case series of children with autoimmune encephalopathies

Abstract

Objective Autoimmune encephalitis refers to an immune-mediated inflammation of the brain, resulting in a wide range of neurological and psychiatric symptoms. We present clinical data alongside the results of serial neuropsychological assessments of children with three types of encephalitis (Hashimoto's encephalopathy, NMDAR-ab and VGKC-ab). Methods Six children presenting to a paediatric neurosciences centre at the Royal Hospital for Sick Children, Glasgow, Scotland were assessed during the acute stage of their illness as in-patients and subsequently for neuropsychological reviews as out-patients. There were two children with Hashimoto's encephalopathy, two children with voltage gated potassium channel antibodies (VGKC-ab), and two children with NMDA receptor antibody (NMDAR-ab). All were treated with immune modulating therapy in the acute and recovery phase of their illness. Average age at first assessment using the WISC-IV (UK) and Childrens Memory Scale (CMS) was 12 years 2 months (SD 2.2) with a median latency to follow-up of 15 months from acute presentation. There was only one male participant (VGKC-ab). Results Full-Scale IQ scores were available for 5 participants. During admission 2/5 scored within the borderline range (5th and 8th percentile), 1/5 within the low average range (19th percentile), and 2/5 within the average range (66th and 73rd percentile). Only 2/5 showed a significant increase in scores at follow-up (borderline to low average; average to superior). There was significant variation within the different indices of the WISC-IV (VCI, PRI & WMI) indicating differential recovery of cognitive functions. CMS (verbal memory) scores were available for 5 participants. 3/5 scored in the impaired range during acute admission, and only 2/5 showed any improvement at follow-up. Conclusion Despite recent improvements in detection, early diagnosis and treatment of children with autoimmune encephalopathies there is a significant burden of cognitive disability and neuropsychiatric disorders in survivors, who require significant longer-term psychosocial intervention.