Pharmacologic Treatment and Early Rehabilitation Outcomes in Pediatric Patients With Anti-NMDA Receptor Encephalitis

Alvarez, Gabrielle; Krentzel, A; Vova, Joshua; Blackwell, Laura S.; Howarth, Robyn

doi:10.1016/j.apmr.2020.09.381

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…In terms of seizure-related outcomes, Alvarez et al suggested that the need for treatment of seizures and movement disorders was predictive of unfavorable early outcomes. However, this was not confirmed by other studies [ 21 ]. Viswanathan LG et al said that there was no significant difference in outcomes such as seizure recurrence, modified Rankin score (mRS) at follow-up/discharge, or relapse between groups of patients who had EEG abnormalities in the first EEG and with those who did not.…”

Section: Reviewcontrasting

confidence: 88%

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Understanding Seizures and Prognosis of the Extreme Delta Brush Pattern in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis: A Systematic Review

Parwani

Ortíz

Alli

et al. 2021

Cureus

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Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) is an autoimmune disorder with neurological and psychiatric features. The disease presents with a viral prodrome, followed by psychiatric manifestations. In the next phase, movement disorders or/and seizures occur. Finally, in the last phase, there is a decrease in the level of consciousness. Central hypoventilation and autonomic dysfunction can occur. Recently a unique EEG (electroencephalogram) pattern has been associated with anti-NMDA receptor encephalitis, the extreme delta brush (EDB). Although the association of the EDB with ANMDARE is known by the medical community, its significance is mainly unknown. A systematic review on NMDARE is also scarce. We decided to conduct a systematic review on this topic to consolidate the knowledge and establish the importance of the EDB as a prognostic factor. To conduct this systematic review, we used only studies conducted in humans, written in English, and published in the last 20 years. We used PubMed as a database and searched the following search terms: ("NMDA encephalitis"[Title/Abstract] AND "Epilepsy"[Title/Abstract]) OR (NMDA encephalitis"[Title/Abstract] AND "seizures" [Title/Abstract]) OR ("NMDA encephalitis"[Title/Abstract] AND "extreme delta brush"[Title/Abstract]). The protocol used for this systematic review was the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) protocol, and to analyze the bias of the studies, we used the ROBINS-1 tool. Eight studies were collected from our search strategy. Our data pulling showed that seizures were present in 178/249 (71.48%) patients. Status Epilepticus was reported in 29/96 (30.20%), and the EBD was seen in 30.89% (55/178) patients with seizures. The range of EDB was 5.9%-33% among the studies. Because the sample size was small, the statistical power was decreased. We had a low overall risk of bias. The wide range in the results could be related to the timing of the EEG recording. EDB was associated overall with increased length of hospital stay, increased ICU admission, and incidence of status epilepticus. The etiology of the EDB remains mainly unknown. However, it has been postulated that in NMDAR encephalitis, there is a disruption of the rhythmic neuronal activity. When antibodies block/target the NMDAR, the rhythmic neuronal activity is disrupted, leading to the unique EDB pattern. Another theory suggests that delta activity is caused because of focal abnormalities in the brain, and the superimposition of the beta waves is related to the alterations of the NMDA receptors.

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Section: Reviewcontrasting

confidence: 88%

“…In contrast, the EDB pattern is often symmetric and synchronous and is typically seen broadly across all head regions [ 20 ]. Another theory proposed that delta activity is caused by focal abnormalities in the brain, and the superimposition of the beta waves is related to the alterations of the NMDA receptors [ 21 ].…”

Section: Reviewmentioning

confidence: 99%

Understanding Seizures and Prognosis of the Extreme Delta Brush Pattern in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis: A Systematic Review

Parwani

Ortíz

Alli

et al. 2021

Cureus

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“…According to a previous study reviewing the progress of inpatient rehabilitation treatment for 26 pediatric NMDARE patients, approximately 65% of patients showed a favorable outcome when the effectiveness of rehabilitation treatment was evaluated with the Functional Independence Measure for children (WeeFIM) [ 14 15 ]. The authors reported that younger age and the presence of epileptic seizures were associated with unfavorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

Cognitive Impairment in a Child With Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report

et al. 2023

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Anti-N-methyl-D-aspartate-receptor encephalitis is a complex autoimmune inflammatory neurological disorder that presents with epileptic seizures and rapid functional deterioration, including movement disorders and cognitive impairment, especially in young patients. Despite aggressive initial treatment with immune therapy, such as corticosteroids, intravenous immunoglobulin, and plasmapheresis, patients often need intensive rehabilitative therapies for their long-lasting deficits. We report a pediatric case of anti-N-methyl-D-aspartate receptor encephalitis in Korea that presented with symptoms of muscle weakness of the four extremities, dysarthria, dysphagia, and cognitive impairment in the acute phase. The patient underwent 4 weeks of comprehensive rehabilitative treatment, including physical therapy, occupational therapy, swallowing rehabilitation therapy, cognitive rehabilitation therapy, and speech therapy. At the follow-up evaluation after 4 weeks of treatment, she showed significant improvements in limb muscle strength, balance ability, swallowing, language function, and the ability to perform activities of daily living. However, when assessed using the Korean Wechsler Intelligence Scale for Children-IV, there was little improvement in cognitive function, particularly in working memory. While only a few cases have reported the progression of cognitive function using a standardized cognitive evaluation tool in patients with anti-N-methyl-D-aspartate receptor encephalitis, this present case report adds to the accumulation of evidence of neurocognitive deficits in these patients.

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Evaluation, Treatment, and Outcomes of Viral and Autoimmune Encephalitis in Children

Vova

Howarth

2023

Pediatric Clinics of North America

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Pharmacologic Treatment and Early Rehabilitation Outcomes in Pediatric Patients With Anti-NMDA Receptor Encephalitis

Cited by 5 publications

References 26 publications

Understanding Seizures and Prognosis of the Extreme Delta Brush Pattern in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis: A Systematic Review

Understanding Seizures and Prognosis of the Extreme Delta Brush Pattern in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis: A Systematic Review

Cognitive Impairment in a Child With Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report

Evaluation, Treatment, and Outcomes of Viral and Autoimmune Encephalitis in Children

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