Resistance Of NMDA Receptor Encephalitis 27 Cases Clinical Characteristics Analysis

Objective Anti-NMDA receptor encephalitis is autoimmune encephalitis which attracted a wide spread attention in recent years,but the difference of clinical characteristics between children and adults is lack of recognition.Through collecting the clinical data of Anti-NMDA receptor encephalitis patients,our study is aimed at comparing the difference of clinical characteristics between children and adults to deepen the understanding of the disease.Methods Adopt the method of retrospective analysis, collect 27 cases who were diagnosed Anti-NMDA receptor encephalitis in first affiliated hospital of GXMU from January 2012 and March 2016. Through collecting the patient’s sex, age, length of hospital stay, clinical manifestation, auxiliary examination, treatment and prognosis of relevant data to analysis of the similarities and differences between them.Results (1) Premonitory symptoms contained headache、fever、upper respiratory infection、nausea、vomit、diarrhea and so on.The occurrence rate was 40% for children,75% for adults,and there was no significant differences between two groups(P>0.05).(2)Initial symptoms contained psychogeny、 epileptic seizure、psychogeny with epileptic seizure, The occurrence rate was 60%、20%、20% for children,42%、33%、25% for adults,and there was no significant differences between two groups(P>0.05). (3) Clinical manifestation: psychogeny、epileptic seizure、involuntary was most common for children,and psychogeny、epileptic seizure、status epilepticus、involuntary、autonomic nerve dysfunction、central hypoventilation was most common for adults,there were significant differences in status epilepticus and central hypoventilation between two groups,which was more common for adults than children(P<0.05).(4) Accessory examination:①cerebrospinal fluid pressure、conventional and biochemical was normal or moderately elevated,and there was no significant differences between two groups(all P>0.05).②Electroencephalogram:For children,15 cases was slow wave,5 cases was 8 brush,4 cases was sample epilepsy wave;for adults,2 cases was β wave,10 cases was slow wave,4 cases was δ brush,6 cases was sample epilepsy wave, and there was no significant differences between two groups(all P>0.05). (5)With tumor:there was no tumor for children,2 female cases were with teratoma of ovaty(7%). (6)Therapy: ①immunotherapy 15 cases were treated with glucocorticoid and immune globulin for children,for adults,3 cases were treated with glucocorticoid,1 case was treated with glucocorticoid and immune globulin,8 cases were treated with glucocorticoid、immune globulin and plasma exchange or immunosuppressor. ②Antiepilepsy medication:for children,10 cases were treated with one drug,1 case was treated with two drugs;for adults,11 cases were all treated with two drugs or more,and there was significant differences between two groups(P< 0.05). (7)Prognosis:①Average hospital stays:20.7±8.2d for children, 43.1±25.1d for adults, and there was significant differences between two groups(P<0.05). ②ankin grade at discharge:2.07±1.39 for children, 3.67±1.72 for adults, and there was significant differences between two groups(P=0.016). ③valuation curative effect with Rankin grade,0-1 was excellent,2-3 was effective,4-5 was inefficacy.For children,12 cases were excellent or effective,3 cases were inefficacy;for adults,4 cases were excellent or effective,8 cases were inefficacy,and there was significant differences between two groups(P<0.05).Conclusions (1)Status epilepticus and central hypoventilation is more common for adults than children. (2)Epileptic seizure is controlled more easily for children than adults. (3)Curative effect and prognosis is well for children than adults.