• J. Neuroimmunol. · Nov 2017

    Anti-N-methyl-d-aspartate receptor encephalitis in children of Central South China: Clinical features, treatment, influencing factors, and outcomes.

    • Ying Wang, Weixi Zhang, Jinghua Yin, Qianjin Lu, Fei Yin, Fang He, and Jing Peng.
    • Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.
    • J. Neuroimmunol. 2017 Nov 15; 312: 59-65.

    Background And PurposeWe analyzed the clinical manifestations of children with anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis in Central South China and the factors influencing the effectiveness of treatment.MethodsA retrospective study of children (0-14years old) with anti-NMDAR encephalitis in Central South China was carried out from March 2014 to November 2016. Demographics, clinical features, treatment, outcome, and the factors influencing the effectiveness of treatment were reviewed.ResultsFifty-one patients with anti-NMDAR encephalitis were enrolled (age from 4months to 14years old; median age, 8years; 30 females). Forty-five patients (88%) presented with psychiatric symptoms, 40 (78%) with dyskinesia and movement disorders, 39 (77%) with sleep disturbances, 34 (67%) with seizures, 30 (59%) with a decreased level of consciousness (Glasgow score<15), 28 (55%) with speech disturbances, and twelve (24%) with autonomic instability. None presented with hypoventilation, and only one patient (female, 14years old) had an ovarian teratoma. All patients received first-line immunotherapy, 25 patients both received firstline and second-line immunotherapy. Forty-four of the 51 patients achieved good outcomes (score on the modified Rankin Scale [mRS] of 0-2), while the other seven had poor outcomes (mRS score of 3-5).ConclusionsThis study investigated the clinical characteristics of children (aged 14 or younger) with anti-NMDAR encephalitis in Central South China. Patients with decreased consciousness, PICU stay and autonomic instability were more likely to have no or limited response to first-line immunotherapy and to require second-line or even more aggressive immunotherapy. Children with anti-NMDAR encephalitis in China have a much lower incidence of tumors, lower mortality rates, and a lower proportion of lethal autonomic instability than adults.Copyright © 2017 Elsevier B.V. All rights reserved.

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