A Clinical Analysis On Epilepsy Associated With Autoimmune Encephalitis In Children

BackgroundAutoimmune encephalitis(AE)is a class of diseases caused by the immune system's abnormal immune response to central nervous system(CNS)components.Seizure is one of its main clinical manifestations.Epilepsy associated with autoimmune encephalitis is different from the other causes of epilepsy in terms of seizure type,seizure form or treatment.At present,there are few clinical studies on this kind of epilepsy in children.ObjectiveWe collected the clinical data of children with autoimmune encephalitis who were admitted to the Department of Pediatric Neurology of the Shandong Provincial Hospital affiliated to Shandong University in the past 5 years.The clinical features of children with epilepsy associated with autoimmune encephalitis were summarized and analyzed.And we discussed the prognosis of this kind of epilepsy in children,in order to provide valuable materials for pediatric neurologists.MethodsA total of 41 children with AE with seizures who were admitted to the Department of Pediatric Neurology of the Shandong Provincial Hospital affiliated to Shandong University from January 01,2014 to August 31,2018 were collected.The general condition and epilepsy characteristics of the children were collected through the electronic medical record system.A retrospective analysis was performed on the clinical data such as seizure performance,application of anti-epileptic drugs(AEDs),immunotherapy and outcomes.Results1.A total of 41 children were included,including 18 males and 23 females.The male to female ratio was 0.78:1.The onset age was 6 months to 13 years and 8 months,with a median age of 7 years and 9 months.46.3%(19/41)of these children had epilepsy,31.7%(13/41)of these children had abnormal mental behavior,and 9.7%(4/41)of these children had cognitive dysfunction.12.2%(5/41)of these children developed onset with non-specific symptoms such as fever,headache,and vomiting.78.1%(32/41)of these children had an acute phase onsets,19.5%(8/41)of these children had a subacute phase onsets,and 2.4%(1/41)of these children had a chronic phase onsets.73.2%(30/41)of these children had secondary generalize seizures,19.5%(8/41)of these children had complex partial seizures,and 7.3%(3/41)had generalized seizures.The generalized seizures are all tonic-clonic seizures.4.9%(2/41)of these children had convulsive status epilepticus(SE).2.Cerebrospinal fluid(CSF)examination:In the antibody positive group,the number of CSF white blood cells was 15.61±10.82×106/L,and in the antibody negative group was 22.32±11.28x106/L.The protein content in the antibody positive group was 0.41±0.28 g/L,and in the antibody negative group was 0.3210.19 g/L3.Electroencephalogram(EEG):82.9%(34/41)of these children had EEG abnormalities,of which 12 cases(29.3%)with slow background activity in EEG,10 cases(24.4%)with generalized or diffuse slow waves,17 cases(41.5%)with epileptic waves,and there were 3 cases(7.3%)in the a-0 band rhythm.This waveform appeared in the non-rapid eye movement(NREM)stage of sleep in children,and there were 2 cases(4.9%)in children with extreme ? brush wave(EDB).4.Magnetic resonance imaging(MRJ):56.1%(23/41)of these children had magnetic resonance abnormalities,and 73.9%(17/23)were appeared in the temporal lobe.26.1%(6/23)of these children's lesions involved the hippocampus,corpus callosum,cortex and the frontal lobe.5.Prognosis:68.3%(28/41)of the children had no seizures and gradually reduced AEDs.19.6%(8/41)of the children had no seizures and continued to use AEDs,4.9%(2/41)The frequency and severity of the attacks were significantly reduced,but there were still episodes.AEDs continued to be used,and 7.3%(3/41)of the children were ineffective.Conclusion1.The epilepsy associated with autoimmune encephalitis in children often occurs in the first 2 weeks from the disease onset,the most seen type of seizures is secondary generalize seizure.The most seen common form of seizures is tonic-clonic seizure.2.The number of cerebrospinal fluid(CSF)cells in children with AE may be slightly increased,the protein content is normal.The increase of white blood cells is not specific,which can not be used as an indicator to judge the severity of the disease or prognosis.3.Most of these children have EEG abnormalities,most of which are non-specific.Patients with severe epileptic discharge or extreme ? brush waves may have poor prognosis.4.Most of these children have satisfactory prognosis after immunotherapy and antiepileptic drugs treatment.