Analysis Of Clinical Features Of Anti-NMDA Receptor Encephalitis In Children: Six Cases Reports

Objective: To analyze the clinical features of anti-NMDAreceptor encephalitis in children to provide evidences forearly clinical diagnosis in order to get early treatment andimprove the prognosis.Methods: We retrospectively analyzed the clinical，laboratory and imaging data as well as follow-up informationand discussed the clinical features and prognosis of sixanti-NMDA receptor encephalitis in children which receivedtreatment in China-Japan Union Hospital from2011to2013.Result: The children were between1-14years old (mean9.2years). Consisted of2cases of males and4cases of females.The mean duration of the disease was around45days. The4caseswere onset as restlessness and irritability. All the patientshad mental and behavioral disorder as well as language barriers.Two of the patients had abnormal movements (included orofacialmovement and involuntary movement of the body).The6cases wereassociated with different degrees of sazure. There were urinaryincontinence in3cases. The4cases occurredautonomic dysfunction. Physical examination of all the patients showedno signs of neurological positioning. It were positive that thecerebrospinal fluid anti-NMDA receptor antibodies of all thepatients. It were positive that serum anti-NMDA receptorantibodies of5cases. The EEG of all the patients revealeddiffuse slowing of waves. Brain MRI of one case showed cerebralastrophy, and others showed hyperintensities on T1orT2-weighted sequences of temporal lobe insula. The MRI findingsof one case was normal. Tumors were no found. There was nocentral ventilatordysfunction. All the patients receivedregular treatment,5cases recovered, they could return toschool for formal education, but leave the sequelae such asmemory loss,3cases leave nighttime sleep disorders. One casesuffer a relapse after follow-up one month. One case was no signof relief. After treatment, the MRI of3cases who have foundedthe evidence of abnormal signal intensity returned to normal.Conclusion: Features of anti-NMDA receptor encephalitis inchildren. The mental and behavioral abnormalities was onset astestiness hyperactivity, irritability in children and oftenoverlooked，followed by increasing loss of consciousness.Movement disorders (the most common is orofacial dyskinesias),seizure, autonomic nervous system dysfunction and so on. The inpaitent children were associated with tumor infrequently.Ventilation dysfunction is rare compare to adults.MRI and EEGhave no specific changes. The specific detection index is thecerebrospinal fluid and serum anti-NMDA receptor antibodies.If it can be diagnosed and treated early, most of the prognosisis good. But it is easy to left with sequelae, such as temporallobe dysfunction or sleep disorder.