Comparison Of Clinical Profile Between Anti-NMDAR Encephalitis And Viral Encephalitis In Children

Objective:The clinical features of 21 children with N-methyl-D-aspartic acid receptor(N-methyl-Daspartate receptor,NMDAR)encephalitis were retrospectively analyzed and compared with viral encephalitis.Methods:Twenty-one children diagnosed as anti-NMDAR encephalitis,who were hospitalized in the department of Pediatric Neurology and Pediatric ICU from May 2013 to December 2018 in the first Hospital of Jilin University,were selected.The general situation,clinical manifestation and auxiliary examination of them were compared to 55 cases of common viral encephalitis during the same time span.Results:In this study,the incidence anti-NMDAR encephalitis was prone to occur in female(80.95%),while there were no gender difference in 55 cases of common viral encephalitis.The patients with anti-NMDAR encephalitis,compared with the viral encephalitis group,the average disease onset age was later(8.25±3.99 yr vs 4.46±3.37yr),the history of previous encephalitis is relatively more common(23.8% vs 7.27%)and the precursor infections were less present(9.52% vs 36.36%).Somepatients accompanied with other immune diseases(19.05%).Compared with the viral encephalitis group,most of the patients with anti-NMDAR encephalitis were sub-acute onset(average: 8.48 + 6.09 d vs 4.46 + 3.37d),and more patients onset with psychiatric symptoms(19.04% vs 3.63%).Mental symptoms(95.23% vs 9.09%),autonomic nervous dysfunction(80.95% vs 0%),speech disorder(80.95% vs 1.81%),motor disorder(66.66% vs 7.27%)and consciousness disorder(76.19% vs 14.54%)were more likely developed during the cause of anti-NMDAR encephalitis compared with common viral encephalitis.However,fever was relatively rare in anti-NMDAR encephalitis(52.38% vs 78.18%).For anti-NMDAR encephalitis,in terms of cerebrospinal fluid test,the white blood cell was more likely increased than that of common viral encephalitis(85.71% vs43.63%).Focal slow wave accompanied by focal discharge in EEG(14.28% vs 0%)and parietal lobe abnormal signals appearing in cranial MRI(28.57% vs 7.27%)were relatively common in patients with anti-NMDAR encephalitis.All comparative items mentioned above were statistically significant(P < 0.05).Conclusion:1.Compared with common viral encephalitis,children with anti-NMDAR encephalitis are more likely occur in school-aged female,with sub-acute onset and less history of precursor infections,as well as relatively common history of previous encephalitis or other immunediseases.2.Compared with common viral encephalitis,children with anti-NMDAR encephalitis are more likely to present psychiatric symptoms,autonomic nervous dysfunction,speech disorder,motor disorder and consciousness disorder during the course of disease.However,fever symptom is relatively rare.3.Compared with common viral encephalitis,children with anti-NMDAR encephalitis are more likely having increased white blood cells in cerebrospinal fluid,focal slow wave accompanied by focal discharges in EEG,and parietal lobe abnormal signals in cranial MRI.