Analysis Of Clinical Features And Prognosis Of Anti-NMDAR Encephalitis In Children

Objective: To summarize the clinical features of children with anti-NMDAR encephalitis and to research the risk factors affecting prognosis in order to provide evidence for predicting prognosis and the treatment.Methods: Retrospective analysis the clinical data of the children with anti-NMDAR encephalitis diagnosed according to the inclusion criteria in the Children's Hospital affiliated to Chongqing Medical University from January 2012 to December 2016.The mRS score was evaluated dynamically and the risk factors affecting the prognosis of children with anti-NMDAR encephalitis were further analyzed.Results: 68 children were included in the study.(1)Children of all ages suffer from the disease,the high incidence age is 6 to 12 years old.(2)The main symptoms are consciousness disorder(87%),mental and behavioral disorder(87%),involuntary movement(85%),language disorder(79%),sleep disorder(78%),and seizures(75%).Pneumonia is the most common complication in acute phase(19%).(3)The detection of anti-NMDAR antibody in CSF of 68 children was positive.The positive rate of anti-NMDAR antibody was 86% tested at the same time in 62 cases.There was a positive correlation between CSF and serum anti-NMDAR antibody titers.(4)There were 59 cases(87%)with background slowness of EEG,17 cases(25%)with epileptic wave and 6 cases(9%)with abnormal ? brush.(5)Brain MRI is abnormal in 28 cases(47%).The abnormity is in one or more brain areas,distributed in thalamus,frontal lobe,parietal lobe,occipital lobe,temporal lobe,cerebellar hemisphere,island lobe,corpus callosum,basal ganglia,hippocampus,periventricular area.However,the abnormities lack of specificity.(6)At 3 months,6 months and 12 months after onset,68 cases,60 cases and 59 cases were followed up.35 cases(51%)turn out good outcome,and 33 cases(49%)turn out bad outcome after 3 months of onset.48 cases(80%)turn out good outcome,and 12 cases(20%)turn out bad outcome after 6 months of onset.54 cases(92%)turn out good outcome,and 5 cases(8%)turn out bad outcome after 12 months of onset.There were 3 cases of death and 4 cases of recurrence.Single factor analysis showed that there were significant differences in age,consciousness disorder,pneumonia between the groups with good outcome and bad outcome 3 months after onset(p < 0.05).The age,CSF leukocyte count,pneumonia were significantly different between the groups with good outcome and bad outcome 12 months after the onset of the disease(p < 0.05).Multivariate logistic regression analysis showed that age was an independent risk factor for short-term prognosis of children with anti-NMDAR encephalitis.Conclusion:(1)Anti-NMDAR encephalitis can be seen in children of all ages,6 to 12 years of age is the high incidence age.(2)Acute or subacute disorders of consciousness,mental and behavioral disorders,involuntary movement,language disorders,sleep disorders,seizures should be highly to be vigilant of anti-NMDAR encephalitis.(3)The diagnosis could be made according to the positive anti-NMDAR antibody in CSF.EEG mainly shows the slow background wave,and a few may shows abnormal ? brushes.However,the change of brain MRI lacks of specificity.(4)Early diagnosis and full course of immunotherapy,most of them have a good outcome.The age of onset,the disturbance of consciousness level,pneumonia and the increase of white blood cell count in CSF may be related to bad outcome.