Analysis Of Clinical Characteristics And Prognosis Of 75 Children With Autoimmune Encephalitis

ObjectiveAutoimmune encephalopathies(AE)is a type of inflammatory disease of the central nervous system mediated by autoimmune mechanisms.Its clinical symptoms mainly include seizures,mental behavior disorders,and speech movement disorders.Among them,seizures are common symptoms of AE one.The pathological manifestations were mainly lymphocyte-based inflammatory cells infiltrating the brain parenchyma and forming cuff-like structures around blood vessels.The incidence of autoimmune encephalitis is 0.8/100,000/year,accounting for about 10%to 20%of patients with encephalitis,of which 80%are anti-NMD AR encephalitis.With the advancement of antibody detection technology,more and more new autoimmune encephalitis-related antibodies have been found,but many patients have negative antibody test results.In order to further improve people's understanding of autoimmune encephalitis,this article summarizes the clinical manifestations,auxiliary examination,treatment and prognosis of AE patients through a retrospective cohort study,with a view to early diagnosis and early treatment to improve prognosis.MethodRetrospective analysis of clinical data of children diagnosed with autoimmune encephalitis in the First Affiliated Hospital of Zhengzhou University from April 2014 to October 2019.The patients all met the diagnostic criteria proposed by the"Consultation of Experts in the Diagnosis and Treatment of Autoimmune Encephalitis(2017)".Recorded information includes the patient's gender,age,first symptoms,auxiliary examinations(including routine biochemical analysis of cerebrospinal fluid,cerebrospinal fluid autoantibody testing,cranial magnetic resonance,PET-CT,EEG),whether he has been in PICU,previous history,whether he has a tumor,treatment Protocol,length of stay,whether to relapse,etc.,and the modified Rankin scale(mRS)was used to evaluate the child's initial hospitalization and discharge status.The mRS score of 0 to 2 was good,and 3 to 6 Poor prognosis.Patients were divided into antibody-positive group and antibody-negative group according to AE-related antibodies,and patients were divided into good short-term prognosis group and poor short-term prognosis group according to mRS score at discharge.Intra-group and inter-group comparison analysis was conducted to explore whether there were differences between the two groups in age,clinical symptoms,auxiliary examinations,and prognosis,so as to promptly diagnose and improve the prognosis.Follow-up observation of epileptic seizures and anti-epileptic drug use after antibody-positive patients were discharged from hospital for half a year.At the end of follow-up,patients were scored using the mRS scale.Patients were divided into two groups according to the presence or absence of seizures during the follow-up period.Seizures and no seizures during the follow-up period,the mRS scores of the two groups were compared,and the effect of seizures in the recovery period on the long-term prognosis of the patients was analyzed.Results1.A total of 75 patients were included in this study.The age of onset was 1 to 17 years,including 34 males and 41 females.The ratio of male to female was 1:1.2.The average age of onset was 8.7 ± 3.9 years.Of the 75 patients,30 had prodromal symptoms,39 had fever,31 had seizures,49 had psychiatric disorders,24 had decreased consciousness,34 had dyskinesia,42 had speech disorders,and 44 had stayed ICU,1 case with teratoma.2.There were 44 cases in the antibody-positive group and 31 cases in the antibody-negative group.The antibody-positive group had a higher proportion of seizures,dyskinesias,and language disorders than the antibody-negative group,and the differences were statistically significant(P<0.05).3.52 patients with good short-term prognosis and 23 patients with poor short-term prognosis.The poor prognosis group had a higher proportion of prodromal symptoms and disturbance of consciousness than the good prognosis group,and the median number of cerebrospinal fluid nucleated cells and initial mRS score was higher than the good prognosis group,and the difference was statistically significant(P<0.05).4.The antibody-positive patients were followed up for six months.During the follow-up period,6 cases had seizures and 38 cases had no seizures.The median mRS score of the group with seizures during the follow-up period was higher than that of the non-seizure group,and the difference was statistically significant.(P<0.05).Conclusion1.Antibody-positive patients are more likely to have clinical manifestations such as seizures,dyskinesia,and language impairment during the acute phase,and antibody-negative patients are more likely to have abnormal magnetic resonance imaging during the acute phase.2.Positive or negative cerebrospinal fluid antibodies have no effect on patients'short-term prognosis.Patients with prodromal symptoms,disturbance of consciousness,significantly increased cerebrospinal fluid nucleated cells,and high initial mRS scores are more likely to have a short-term prognosis.3.Long-term prognosis is poor in antibody-positive patients with seizures during recovery.