Pediatric Autoimmune encephalitis: Experience from a Tertiary Care Hospital in Bangladesh

Kanij Fatema,Md Mizanur Rahman

doi:10.17724/jicna.2021.200

Abstract

Background: Autoimmune encephalitis (AIE) are distinct group of encephalitis where production of autoimmune antibody causes neuroinflammation. The core clinical features are encephalopathy, psychiatric disorder, movement disorder and seizure. The investigation and treatment modalities are different from that of infectious encephalitis. There are limited studies in pediatric population in particularly in developing country like Bangladesh. Thus this study has been done to describe patients with AIE from a tertiary care hospital. Method: This is a retrospective study done in children of 1-16 year from January 2018 to December 2019. AIE was diagnosed on the basis of clinical, electrographic and neuroimaging features and was confirmed with detection of autoantibody in CSF. Treatment was given according to the published literature with immunotherapy mainly. Results: Total 15 children were studied, 14 patients were antiNMDAR encephalitis and 1 was antiMOG antibody syndrome. Mean age was 5.98 and 4.5 year respectively. Seizure was the most common clinical feature, mostly focal in nature. Other manifestations were movement disorder, psychiatric disorder, loss of consciousness etc. Most of the patients had abnormal EE, focal epileptic discharge being the commonest. Eight out of 15 had abnormal MRI of brain. Cortical hyperintensity was important feature located mostly in temporal region. In the case of antiMOG antibody syndrome there was demyelinating lesion in multiple areas. Cornerstone of the treatment was mostly combination immunotherapy with IV methylprednisolone and IV immunoglobulin followed by oral steroid. Majority of the patients showed improvement however 3 patients had complete recovery. Complications observed were epilepsy, speech disorder, cognitive disorder, behavioural disorder, ataxia and visual impairment. Conclusion: Timely diagnosis and prompt treatment of AIE is very important as proper treatment can cause significant improvement.

Highlights

Autoimmune encephalitis (AIE) is a type of antibody-mediated inflammatory disorder of the central nervous system
Clinical demography of studied children: In this study, a total of 15 children diagnosed with AIE were analysed
Clinical features of the studied subject: About 42.8% patients of anti-NMDAR encephalitis presented with a prodrome of fever and one patient of anti-myelin oligodendrocyte glycoprotein (MOG) had fever

Summary

Introduction

Autoimmune encephalitis (AIE) is a type of antibody-mediated inflammatory disorder of the central nervous system. AIE is manifested by various neurological and psychiatric symptoms. Many of the AIE disorders have been described with the advent of molecular diagnostics. The incidence of AIE has been rising globally and presents an emerging form of encephalitis. Research has evidenced an interest in AIE, as the modality of diagnosis and management is different from that of infectious encephalitis, in that detection of autoantibodies is important and immunotherapy is the cornerstone of treatment [5, 6]. In a resource-limited country such as Bangladesh, AIE diagnosis is difficult and expensive.

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