Clinical Characteristics Of Autoimmune Encephalitis In Children And The Effect Of Plasma Exchange Therapy

Autoimmune encephalopathy?AE?is a newly discovered immune encephalitis mediated by antigen and antibody in recent years.Its clinical manifestations include decreased consciousness,epilepsy,dyskinesia and mental disorders.It usually responds well to immunotherapy such as glucocorticoid or gamma globulin.However,it has been found that some severe patients have poor response to glucocorticoid and gamma globulin alone or in combination in recent years.If plasma exchange?PE?is applied in time,it can significantly improve the clinical symptoms and reduce the occurrenceofsequelae^[1].Thisstudyretrospectivelyanalyzedtheclinical characteristics and the efficacy of PE in children's AE.From this study we can understand the clinical characteristics of children's AE and the application value of PE in children's AE well.And we hope that it can provide a theoretical basis and practical guidance for clinical diagnosis and treatment.Objectives:From January 2013 to December 2018,the clinical data of diagnosed or highly suspected AE in pediatric intensive care unit of the firstHospital of Jilin University were collected and summarized.And the clinical characteristics of severe AE were analyzed retrospectively.The therapeutic effect of PE in children with severe AE was observed and analyzed.It is hoped that it can provide a certain theoretical basis and practical significance for clinical diagnosis and treatment.Methods:From January 2013 to December 2018,the data of 40 children with autoimmune encephalitis diagnosed or clinically suspected in the pediatric intensive care unit of the First Hospital of Jilin University were collected.40 children were enrolled in the group through strict inclusions and exclusion criteria.The data was collected that it include:?1?General data of the children enrolled in the study,such as age,sex,weight,Onset time.?2?The clinical manifestations of the enrolled children,such as state of consciousness,epileptic seizures,motor abnormalities,mental disorders and so on.The improvement of the clinical symptoms in children were compared after PE treatment.?3?The results of auxiliary examinations such as cerebrospinal fluid?CSF?,electroencephalogram?EEG?and magnetic resonance imaging?MRI?of the children in the group.?4?The prognosis of the enrolled children,such as mortality rate,improvement rate,etc.?5?Complications occurred in the enrolled children.?6?The changes of Glasgow Coma Scale?GCS?in Glasgow children before and after PE treatment were recorded.In this study,SPSS18.0 statistical software was used to analyze and process the data of all cases.The mean and median were used to describe the measurement data.The number and percentage of cases was used to describe the counting data.Paired t test was used to compare the normal distribution of the measurement data group..P<0.05 was statistically significant.Results:?1?Among the 40 patients,19 were boys and 21 were girls.The sex ratio was1:1.1.The age distribution ranged from 3 to 16 years.The average age was 10.6 years?8.96,12.23?.The weight ranged from 13.7 kg to 44.6 kg.The average weight was30.59 kg?26.71,34.46?.The Onset time was from 4 days to 20 days,and the average time was 11.25 days?9.1,13.3?.?2?The most common clinical manifestations were decreased level of consciousness and cognitive impairment,followed by seizures and mental disorders.There were 40 cases?100%?which had decreased level of consciousness and cognitive impairment.36 cases?90%?had seizures.35 cases?87.5%?had mental disorders.35 cases?87.5%?had mental disorders.And 10 cases?25%?had been diagnosed with psychotic symptoms as the first symptom.After PE treatment,the clinical symptoms of most children were improved to some extent.?3?The results of CSF or?and?blood examination showed that 12 children were positive for autoimmune antibodies.All of them were N-methyl-D-aspartate receptor?NMDAR?antibodies.The biochemical examination of CSF showed that 18 children had abnormal manifestations that elevated cell number or protein.?4?The results of head MRI showed that half of the patients had abnormal high signal in T2/FLAIR imaging in unilateral or bilateral frontal of temporal and cuspid lobes.?5?Most of EEG examinations of the enrolled children showed slow wave release,diffuse delta or theta wave,focal sharp wave and sharp slow wave release in varying degrees.?6?The clinical prognosis of the children in the group was improved in 35 cases.5 cases were died.The mortality rate was 14.2%.And the improvement rate was 87.5%.?7?There were 8 cases of complications during PE treatment.The most common complication was anemia.?8?The GCS of the children before PE treatment ranged from 7 to 12,with an average score of 9.05?8.31,9.78?.After treatment,the GCS scores ranged from 3 to 15,with an average score of 12.85?10.87,14.82?.The GCS of the children after PE treatment were significantly higher than those before treatment,P<0.05,it had statistical significance.Conclusion:?1?Most children with severe AE have acute onset.Most of them occur in school-age children.The most common clinical manifestations of severe AE in children are decreased level of consciousness and cognitive impairment,followed by seizures and mental disorders.Psychiatric symptoms may be the first symptom.?2?PE treatment in children with severe AE can significantly improve the clinical symptoms and the rate of improvement.