| ObjectiveThe clinical characteristics of children with AE were summarized,the differences between antibody positive group and antibody negative group were compared,and the factors affecting short-term prognosis were compared.It is committed to providing valuable reference materials for pediatricians.MethodsThe clinical data of children with autoimmune encephalitis diagnosed in the Department of Pediatric Neurology of Chenzhou Hospital to Nanhua University from January 2015 to June 2020 were analyzed retrospectively.The clinical data included age,sex,initial symptoms of the first onset,auxiliary examination:cerebrospinal fluid autoantibodies,serum autoantibodies,routine biochemistry of cerebrospinal fluid,cranial magnetic resonance imaging,electroe-ncephalogram,electrolyte biochemistry,C-reactive protein,antistreptolysin“O”,Serum uric acid,tumor,epilepsy,treatment,hospitalization,Check into PICU,recurrence and so on.The modified Rankin scale(m Rs)was used to evaluate the condition of the patients at discharge,1 month,3 months and 6 months after discharge.The prognosis was good at 0～2 and poor at 3～6.Patients were divided into autoimmune antibody positive group and autoimmune antibody negative group according to the situation of cerebrospinal fluid and serum antibodies in children with AE.In addition,statistical analysis was made between the two groups.The patients were divided into two groups:good short-term prognosis group and poor short-term prognosis group according to the m Rs score at discharge,and statistical analysis was carried out between the two groups.All children were followed up for 6months from the end of the first discharge time.At the end of follow-up,the patients were divided into two groups:good prognosis group and poor prognosis group according to m Rs score,and statistical analysis was carried out between the two groups.Patients were divided into autoimmune antibody positive group and autoimmune antibody negative group according to the situation of cerebrospinal fluid and serum antibodies in children with AE.In addition,statistical analysis was made between the two groups.The patients were divided into two groups: good short-term prognosis group and poor short-term prognosis group according to the m Rs score at discharge,and statistical analysis was carried out between the two groups.All children were followed up for 6 months from the end of the first discharge time.At the end of follow-up,the patients were divided into two groups: good prognosis group and poor prognosis group according to m Rs score,and statistical analysis was carried out between the two groups.Results1.58 cases were diagnosed as autoimmune encephalitis,accounting for 46.5% of males and 53.5% of females,with a male-to-female ratio of about 0.87.In addition,the age of seeing a doctor was between 1 and 16 years old,and 50% of the children were between 9.0±3.8 years old.2.The most common initial symptoms were fever and abnormal mental behavior among the 58 diagnosed children.32.9% of the children had fever when they were admitted to hospital,and 25.8% of the children developed mental and behavioral abnormalities.41(70%)of the 58 diagnosed children had mental and behavioral abnormalities,and 36(62.0%)had autonomic nervous dysfunction.Moreover,34(58.6%)had motor dysfunction and 31(53.4%)had sleep disorders.In addition,30(51.7%)had fever,and 30(51.7%)had cognitive impairment.Besides,22(37.9%)had convulsions or seizures,and 22(37.9%)had speech disorders.In addition,16 cases(27.5%)had disturbance of consciousness,14 cases(24.1%)had memory loss and 1 case(1.7%)was complicated with pineal tumor.3.23(39.6%)of the 58 diagnosed children had positive changes in cerebrospinal fluid,48(82.7%)had abnormal EEG,and 36(62.1%)had abnormal craniocerebral MRI.4.28(48.2%)of the 58 diagnosed children were positive for autoimmune antibodies,and 17/28(60.7%)were anti-NMDAR encephalitis.In addition,14.3%(4/28)were anti-mog encephalitis,and 4/28(14.3%)were anti-CASPR2 encephalitis.Besides,1/28(3.6%)were anti-LGI1 encephalitis,and 2/28(7.1%)were multiple autoimmune antibody positive encephalitis.5.A total of 98.2% of the 58 diagnosed children received immunotherapy,and 3/57(5.3%)of the children were treated with C-ball alone,Besides,8/57(14.0%)were treated with hormone alone,and 43/57(75.4%)were treated with C-ball + hormone.Moreover,3/57(5.3%)were treated with C-ball + hormone + immunosuppressants.The patients in the group did not use plasma exchange therapy for first-line immunotherapy.6.Epileptic seizures(p=0.001)and motor dysfunction(p=0.018)were more common in the antibody positive group than in the antibody negative group.In addition,the length of hospital stay in the negative group was longer than that in the positive group(p=0.039).7.The long-term prognosis of 52/58(89.4%)the children was good,6/58(10.3%)of the children had a poor long-term prognosis,and 8/58(13.8%)of the children had relapse.Moreover,the short-term prognosis of children with speech disorder(p=0.001),cognitive impairment(p<0.001)and fever(p=0.014)was relatively poor when they were discharged from hospital.Conclusions1.Children with antibody positive AE were more likely to have seizures and motor dysfunction than children with antibody negative AE.Besides,the average hospitalization time of antibody negative AE children was longer than that of antibody negative children.2.Anti-NMDAR encephalitis is a common type in children’s AE,and multiple autoimmune antibody positive encephalitis.3.The short-term prognosis of children with speech disorder,cognitive impairment and fever was even worse;Most of the children with AE have a good long-term prognosis after immunotherapy. |
