Clinical Features And Prognostic Factors Analysis Of Children With Seizure Associated With Anti-nmdar Encephalitis

Objective:To summarize the clinical features of seizures at acute phase and long-term outcome of seizures associated with anti-N-methyl-D-aspartate receptor(anti-NMDAR)encephalitis in children,and to explore potential factors associated with seizure outcome,so as to provide information for diagnosis and treatmeant.Methods:This study retrospectively collected and summarized 62 children's clinical data and follow-up results of acute and chronic seizures who were diagnosed with anti-NMDAR encephalitis in Children's Hospital of Chongqing Medical University from Aug.2012 to Jun.2018.Results:(1)62 children(62/86,72.1%)had seizures at acute phase,0f which 58 children(58/62,93.6%)had seizures within 2 weeks of course,2 children(2/62,3.2%)had seizures at 2 to 4 weeks of course,2 children(2/62,3.2%)had seizures after four weeks of course.36 children(36/62,58.1%)presented initially with a seizure,and the initial symptoms with seizures occurred more often in male than female(P<0.05).(2)The manifestations of seizure were varied,45 children(45/62,72.6%)manifested only one kind of epileptic types,17 children(17/62,27.4%)manifested at least two kind of epileptic types.Generalized tonic or tonic-clonic seizures accounted for 34(34/62,54.8%),focal to bilateral tonic-clonic seizures accounted for 25(25/62,40.3%),focal onset impaired awareness seizures accounted for 10(10/42,16.1%),focal onset aware seizures accounted for 11(11/62,17.7%).Convulsive status epilepticus(CSE)accounted for 15(15/62,24.2%),nonconvulsive status epilepticus(NCSE)accounted for 2(2/62,3.2%).(3)Results of cerebrospinal fluid examination in children with anti-NMDAR encephalitis were similar to that of viral encephalitis,with slightly elevated or normal white blood cells and proteins,without decrease of sugar and chloride.The positive rate of electroencephalogram(95.2%)was significantly higher than that of brain agnetic resonance imaging(45.0%).Extreme delta brush(EDB)was less common in adults(6.5%).3 chilren exhibited non-convulsive seizures,2 of them exhibited NCSE.(4)All of the children were treated with intravenous immunoglobulin and/or glucocorticoid,2 of them added plasma exchange,2 of them added second-line immunotherapy,rituximab.45 children(45/62,72.6%)were treated with AEDs at acute phase,27(27/62,43.6%)of them with single drug,17(17/62,27.4%)of them with two drugs,1(1/62,1.6%)of them with three drugs.The average duration of AEDs treatment was 3.58±1.08 months in the group of good short-term prognosis,and 8.40±1.14 months in the group of poor short-term prognosis(the median duration was 8 months,7-12 months).No seizure occurrence was observed in all children during the follow-up period after AEDs withdrawal.(5)The short-term prognosis was good in 48 children,poor in 5 children and 1 child died.Only 8%(5/62)of the children had seizures in the chronic phase.On the univariate analysis,SE or AEDs combination in the acute phase might be related to poor prognosis of seizures outcome associated with anti-NMDAR encephalitis(P <0.05).No independent risk factors of poor prognosis of seizures associated with anti-NMDAR encephalitis were found.Conclusion:(1)Seizures can manifeste at any stage of the disease,with a variety of manifestations,and some children exhibited SE.There exists gender difference in seizures as initial symptoms of anti-NMDAR encephalitis.(2)Continuous EEG monitoring is crucial for identifying SE symptoms such as NCSE.(3)Long-term prognosis of seizures associated with anti-NMDAR encephalitis is good,and long-term use of AEDs may not be necessary.(4)No independent risk factors of poor prognosis of seizures associated with anti-NMDAR encephalitis were found.