The Efficacy Of First-Line Immunotherapy And The Prognosis In Children With Anti-NMDAR Receptor Encephalitis

Objective:To observe and analyze the influence factors for the first-line immunotherapy applied in anti-NMDA receptor (NMDAR) encephalitis,and evaluate the prognosis of the children with NMDAR encephalitis. And then, provide some meaningful instructions for the standardized treatment of children with NMDAR encephalitis.Methods:A retrospective study included 37 Children with NMDAR encephalitis,who admitted in the First Affiliated Hospital of Guangxi Medical University and the People’s Hospital of Liuzhou City on June 2014 to November 2015.The following variables collected from the case records were analyzed:gender,age of onset,prodromal symptoms,main symptoms,maximum mRS and the period between it and the first symptom,if the child was sent to the intensive care unit,the result of MRI,if the child had the tumor,the period between first symptom and the start time of first-line immunotherapy,the period between the start time of first-line immunotherapy and the time that child’s condition improved significantly,and the method of first-line immunotherapy.The therapeutic effect and prognosis were observed by telephone follow-up. We analyzed the demographic information and symptoms by Fisher exact test or two-sample t test,and we used the ordinal logistic regression for the single factor and multiple-factor analysis of the result.Results:There was no statistically significant difference among the groups that were grouped by the gender or the method of first-line immunotherapy. We took the mRS at the time when the child was released from the hospital for 2 months as the dependent variable,the result that analyzed by the ordinal logistic regression showed that the age of onset,the maximum mRS and the period between the start time of the first-line immunotherapy and the time that child’s condition improved were significantly associated with the good therapeutic effect(mRS≤2).All of them achieved a good prognosis (mRS<2), and the median time is 3 month,while only two children (5%) relapsed.ConcIusions:Most Children with anti-NMDAR encephalitis achieved a good prognosis.The older age of onset,the lower maximum mRS,and the shorter period between the start time of the first-line immunotherapy and the time that child’s condition improved are positively associated with the therapeutic effect and the prognosis.