Clinical manifestations, treatment outcomes, and prognostic factors of pediatric anti-NMDAR encephalitis in tertiary care hospitals: A multicenter retrospective/prospective cohort study

Pruetarat, Napa; Netbaramee, Wiracha; Pattharathitikul, Siriporn; Veeravigrom, Montida

doi:10.1016/j.braindev.2018.12.009

Cited by 22 publications

(19 citation statements)

References 15 publications

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“…While in our study, the mean age at onset was 6.3 ± 3.1 years old which was slightly younger (See Additional le 1: Table S1). In addition, the onset age of boys in our study was younger than that of girls, which was different from the outcomes of UK and Thailand studies [13,12]. These differences suggested that the demographics feature of age might range from regions and nations.…”

Section: Discussioncontrasting

confidence: 95%

“…The ratio of patients with good prognosis in our study was 76.6% which similar to other study [30,16,10,14,12]. The predictors of poor outcome in previous study including decrease consciousness, speech disorder, longer hospital day, higher initial mRS, and treatment with RTX were consistent with the outcomes of our study [30,16,10,14,12,31]. Byrne et al found the patients who recovered completely had shorter interval (15 days) between onset and initiation of treatment than that of those who did not recovered completely (21 days) [32].…”

Section: Discussionsupporting

confidence: 91%

“…Male, lesions in brain MRI and autonomic dysfunction served as predictors of poor outcome in our study, although previous study did not [30,16,10,14,12,31]. We found patients aged 3 years or younger was a risk factor for outcome.…”

Section: Discussioncontrasting

confidence: 48%

“…We found patients aged 3 years or younger was a risk factor for outcome. The previous study involved both pediatric and adult anti-NMDAR encephalitis, found the younger age was a predictor of poor outcome [20], although the study only concentrating on pediatric patients did not found [16,14,12]. In our study, we found prodromal event was also associated with poor outcome that is rarely analyzed in previous studies.…”

Section: Discussioncontrasting

confidence: 42%

“…According to previous studies, pediatric anti-NMDAR encephalitis in China and other countries was more common in children aged around 8-12 years [3,[12][13][14][15][16]. While in our study, the mean age at onset was 6.3 ± 3.1 years old which was slightly younger (See Additional le 1: Table S1).…”

Section: Discussionsupporting

confidence: 39%

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Pediatric Anti-NMDAR Encephalitis in Southern China: Analysis of 107 Cases

Hou

et al. 2020

Preprint

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Background: Research on pediatric anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is limited. We studied clinical features of children with anti-NMDAR encephalitis in southern China.Methods: Pediatric anti-NMDAR encephalitis between 2014 and 2019 from one tertiary medical center was analyzed. The Modified Rankin Scale (mRS) score was adopted to evaluate outcomes.Results: 107 children (M/F=50/57; mean onset age=6.3 y) with anti-NMDAR encephalitis were involved. Boys significantly showed earlier onset age, higher ratio of fever, longer hospital day, more courses of steroid treatment, higher mRS score after treatment. 48.6% of patients had prodromal events with infectious events most common. The most common symptom at onset and during whole course was seizures and psychiatric symptoms respectively. Initial median white cell count of cerebral spinal fluid (CSF) was 22.0x106/L. 12.1% of patients had positive herpes simplex virus DNA of CSF. All patients had CSF positive NMDAR antibodies, although 86.9% of patients had serologically positive. 9.3% of patients had overlapped other neuronal antibodies. Electroencephalograph showed abnormalities with slow wave (95.3%) and epileptic activity (41.5%). Delta brush was revealed in 3.8% of patients. 36.4% of patients had lesions in brain MRI, with local lesions most common. No tumor was found in all. 84.9% of patients responded well to the first line therapy (steroid plus immunoglobulin), while 12 patients accepted second-line therapy (Rituximab) with 91.7% of effective rate. 12.1% of patients relapsed. 2 male patients died. The median length of hospital stay was 28 days. The mRS score was significantly improved after treatment. 51.0% of patients had a full recovery. 76.6% of patients had mild neurological disability (mRS≤2). Male, speech disorder, initial score of mRS and administration of second-line therapy were independent risk factors associated with the outcome.Conclusions: Of pediatric anti-NMDAR encephalitis in southern China: the mean onset age was about 6-year-old, earlier in boys; boys remained slower to recover and with a worse prognosis; the most common respective symptom at onset and during whole course was seizures and psychiatric symptoms; combination with tumor was rare; most patients respond well to the immunotherapy; relapse and fatality rate were relatively low; most patients had a good prognosis.

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Section: Discussioncontrasting

confidence: 95%