Clinical Features Of Children With Autoimmune Encephalitis

BackgroundIn recent years,with the progress and popularization of detection means,and to a deeper understanding of the disease,the incidence of autoimmune encephalitis(AE)is higher which imposed a heavy economic burden on society and families.The clinical manifestations of autoimmune encephalitis are varied and the diagnosis of the disease often depends on the detection of laboratory antibodies.However,the detection of antibody which only carried out in some special laboratories is complex and expensive,which affected the diagnosis and treatments of the disease.Therefore,this paper retrospectively analyzed the clinical manifestations,auxiliary examinations and treatments of children with autoimmune encephalitis,and explored the possible factors influencing the detection of antibody and the prognosis of children.ObjectiveThis paper aims to analyze the clinical manifestations,auxiliary examinations,treatments and prognoses of children with autoimmune encephalitis in our hospital by analyzing the possible inner relationship between such findings and the antibody detection or prognoses in statistics to attach the importance to autoimmune encephalitis by the clinician,which provides diagnosis and therapy references for clinics and improves the patients'prognosis.MethodsWe conducted a retrospective review of all patients with autoimmune encephalitis treated at the children hospital of Zhejiang University School of Medicine from January2014 and August 2019.According to the inclusion criteria,we classified patients into the confirmed group and the suspected group.In the children of confirmed group,we collected and compared the clinical manifestations,auxiliary examinations,and treatments between antibody positive group and antibody negative group,also compared them between patients with good outcomes or poor outcomes.Results1. Basic information:Among children with autoimmune encephalitis in 82confirmed diagnosis group,the median hospitalization costed 25,054.71 yuan,the median hospitalization time was 18 days,the ratio of male to female was 0.952:1,and 1child suffered with tumor;2. Clinical manifestations:The most common initial clinical manifestations are seizure(61%)and psychiatric symptoms(45.1%).Of the 16 children admitted to ICU,up to 10 were admitted due to consciousness disorder,and 4 were admitted due to status epilepticus.3. Auxiliary examinations:59% of the confirmed diagnosis group children had abnormal cerebrospinal fluid,61.7%had abnormal cranial imaging,and 76.8%had abnormal electroencephalography.4. Antibody detection:Of the 82 confirmed diagnosis group cases,36(43.6%)were positive for antibody.The cases of children with movement disorders on admission(10vs5,p=0.049)and the ratio of CD4~+/CD8~+T cells in peripheral blood[1.6(1.2?2.0)vs1.1(0.9?1.5),p=0.005]was higher in the antibody positive group.5. Treatments:Among the children of confirmed diagnosis,eighty-one patients received first-line treatment(glucocorticoid,immunoglobulin,plasma exchange),of which 11 received second-line treatment(rituximab,cyclophosphamide).The glucocorticoid pulses(GCP)combined with immunoglobulin was the most common treatment(n=47,57.3%)among all patients,followed by GCP alone(n=19,23.2%),followed by GCP combined with immunoglobulin and rituximab(n=7,8.5%).6. Prognoses:Patients had relatively poor outcomes if they were presented with ICU support(p=0.090),seizure(p=0.015),and abnormal electroencephalogram(p=0.022),while the prognosis of the children with psychiatric symptoms at the time of admission or abnormal cranial imaging was better than those without.Second-line treatment was associated with better outcome(8vs4.2).7. Suspected patient statistics:among the 10 suspected patients,8 patients had psychiatric symptoms or consciousness disorder on admission,4 had seizure on admission,and 80%of the suspected patients had normal cranial imaging and EEG examinations or unexamined.All the 10 suspected children were hospitalized for a short time,and 5 of them were discharged automatically,which caused difficulties in the diagnosis and treatment of the disease.ConclusionsAutoimmune encephalitis has caused a heavy economic burden on society and families.Among children with AE,the common initial clinical manifestations are seizure and psychiatric symptoms.While the common etiology of admission to ICU is consciousness disorder and status epilepticus.Children with motor disorders at the time of admission and increased CD4~+/CD8~+T cell ratio in peripheral blood were more likely to have positive AE antibody.Children with ICU support and seizure had a poor outcome.Second-line treatment has certain benefits to the prognosis,and should be actively recommended for children with bad result.