Clinical characteristics and pathogen screening of 38 children with anti -N-methyl -D-aspartate receptor encephalitis
10.3760/cma.j.issn.2095-428X.2018.05.014
- VernacularTitle:儿童抗N-甲基-D-天门冬氨酸受体脑炎38例临床特征及病原筛查
- Author:
Xiaotang CAI
1
;
Dan YU
;
Yongmei XIE
;
Rong LUO
;
Zhiling WANG
;
Liyuan WANG
;
Yi LIAO
;
Hui ZHOU
;
Haitao REN
Author Information
1. 610041成都,四川大学华西第二医院儿童神经消化科,四川大学出生缺陷与相关妇儿疾病教育部重点实验室
- Keywords:
Anti-N-methyl-D-aspartate receptor encephalitis;
Pathogen;
Child
- From:
Chinese Journal of Applied Clinical Pediatrics
2018;33(5):384-388
- CountryChina
- Language:Chinese
-
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 progno-sis 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 mycoplas-ma pneumonia treatment.Thirty-seven cases received immunosuppressant therapy(4 cases were treated with glucocor-ticoid,12 cases were treated with glucocorticoid combined with immune globulin,2 cases were treated with glucocorti-coid 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-patho-genic treatment may be helpful for disease remission.