Analysis Of Clinical Characteristics Of 90 Cases Of Pediatric Anti-nmdar Encephalitis

Objective: In order to study the clinical characteristics of pediatric anti-NMDAR encephalitis,to improve the understanding of anti-NMDAR encephalitis,to help early diagnosis and treatment of the disease and to improve the prognosis.Methods: The clinical data of 90 cases of pediatric anti-NMDAR encephalitis from August 2012 to January 2018 in our hospital were retrospectively analyzed.Results:(1)Seizure was the most common symptom of the disease.Movement disorder,psychiatric symptom,and seizure are the most common clinical manifestations.Cerebrospinal fluid abnormality might occur in a small group of children.More than 90% have abnormal electroencephalogram,and about 50% had abnormal brain MRI.Most patients had favorable prognosis after immunotherapy,and only a small part of the Children had nervous system sequelae or death.(2)Through statistical analysis,we found that there were statistically significant differences in cognitive dysfunction,consciousness disorder,more than 5clinical manifestations in course of the disease,severe abnormalelectroencephalograph,onset time of immunotherapy and history of viral encephalitis between the group of the time of hospitalization less than 4weeks after immunotherapy and the group of more than 4 weeks after immunotherapy.(3)Through statistical analysis,we found that there were statistically significant differences in movement disorder,psychiatric symptom and more than 5 clinical manifestations in course of the disease between the group of NMDAR antibody double positive in blood and cerebrospinal fluid and the group of NMDAR antibody positive in cerebrospinal fluid.Conclusion:(1)The history of viral encephalitis before onset of the disease,consciousness disorder,cognitive dysfunction,and severe abnormal electroencephalogram might indicate the severe clinical symptoms and long hospitalization time.(2)Serum anti-NMDAR antibody positive may be related to mental and behavioral disorders and dyskinesia symptoms.(3)Many clinical manifestations,including mental and behavioral disorders,disturbance of consciousness,cognitive impairment and dyskinesia,cerebrospinal fluid and serum anti-NMDAR antibody double positive,and abnormal "delta brush" in electroencephalogram,might indicate a higher mortality rate.(4)Early use of immunotherapy for anti-NMDAR encephalitis could shorten the time of hospitalization,and had better effect.If the first-line immunotherapy is not effective,early initiation of second-line immunotherapy could improve the prognosis of the disease.