Risk factors and prognosis of anti-N-methyl-D-aspartate receptor encephalitis following herpes simplex virus encephalitis in children
10.3760/cma.j.cn112140-20250102-00007
- VernacularTitle:儿童单纯疱疹病毒性脑炎继发抗NMDAR脑炎的危险因素及预后分析
- Author:
Guohan YANG
1
;
Fang FANG
;
Changhong REN
;
Xiaotun REN
;
Bing HU
;
Weihua ZHANG
Author Information
1. 首都医科大学附属北京儿童医院神经内科，北京 100032
- Publication Type:Journal Article
- Keywords:
Encephalitis, herpes simplex;
Receptors, N-methyl-D-aspartate;
Risk factors;
Prognosis
- From:
Chinese Journal of Pediatrics
2025;63(6):649-654
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the risk factors and prognosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis following herpes simplex virus encephalitis (HSE) in children.Methods:A retrospective cohort study was conducted on 83 children with HSE hospitalized at Beijing Children′s Hospital, Capital Medical University, from January 2013 to June 2023. The clinical data, including demographics, clinical manifestations, Glasgow coma scale (GCS) scores, auxiliary examinations, and treatment regimens, were collected. The prognoses of these children were evaluated using the modified Rankin scale (mRS), pediatric cerebral performance category (PCPC) scale, and pediatric quality of life inventory (PedsQL). These children were divided into 2 groups: those who developed secondary anti-NMDAR encephalitis and those who did not. Non-parametric tests were used for intergroup comparisons, and Logistic regression models were applied to identify risk factors for secondary anti-NMDAR encephalitis.Results:Among the 83 children with HSE, 23 children developed secondary anti-NMDAR encephalitis. The secondary anti-NMDAR encephalitis group exhibited a later age of onset compared to the non-secondary group (4.0 (2.2, 7.1) vs. 1.6 (0.8, 5.4) years, Z=2.19, P=0.028), lower GCS scores (8.0 (5.5, 11.5) vs. 14.0 (9.8, 15.0) points, Z=3.74, P<0.001), and worse prognostic outcomes as measured by mRS, PCPC scale and PedsQL (3.0 (2.0, 5.0) vs. 1.0 (0.3, 3.0) points, 3.0 (2.0, 4.0) vs. 2.0 (1.0, 4.0) points, 52.0 (17.0, 67.0) vs. 86.5 (53.3, 97.5) points, Z=3.48, 3.36, 3.09, all P<0.01). Logistic regression analysis identified lower GCS scores during HSE as an independent risk factor for the secondary anti-NMDAR encephalitis ( OR=0.82, 95% CI 0.72-0.94, P=0.003). Conclusion:For the children with HSE who present low GCS scores, regular follow-ups are imperative in order to monitor for the potential development of anti-NMDAR encephalitis, thus facilitating early intervention and improving clinical outcomes.
