| Objective: To analyze the clinical data of children with anti-N-Methyl-D-Aspartate Receptor(NMDAR)encephalitis admitted to Children’s Hospital of Chongqing Medical University,and to summarize the characteristics of children with anti-NMDAR encephalitis in our country;analyze the relevant factors affecting the prognosis of children with anti-NMDAR encephalitis,in order to guide early diagnosis,intervene in time to improve the prognosis of children.Methods: Collect the clinical data of 173 children with anti-NMDAR encephalitis who were admitted to the Children’s Hospital of Chongqing Medical University from January 2014 to December 2019,and retrospectively analyze the clinical characteristics,auxiliary examinations,therapeutic method,prognosis,and summarize the clinical characteristics;146 children were followed up for at least 6 months,they were divided into a good prognosis group and a poor prognosis group.The clinical differences between the two groups of children were compared,further,there were statistical differences between the two groups The univariate variables of the above are introduced into logistics regression to explore the relevant factors that affect the prognosis.Results:(1)This study included 173 children with anti-NMDAR encephalitis(male/female=1:1.44;mean age of onset=7.8±3.6 years,ranged from 8 months to 15 years old);(2)35.2% had prodromal symptoms,13.3% had a history of viral encephalitis 20-60 days before onset;(3)abnormal psychiatric behavior(67/173,39.9%)and seizures(67/173,38.7%)were the most common first symptoms,the most common cumulative symptoms in the course of the disease were abnormal psychiatric behavior(147/173,85.0%)and dyskinesia(141/173,81.5%);(4)6 cases were combined with positive serum anti-MOG antibody;anti-NMDAR antibody in the cerebrospinal fluid of all 173 children were positive,but among 152 serum samples,23 cases were negative;(5)The abnormal rate of the first EEG was 79.1%,manifested as diffuse slowing,focal slowing,and epileptic waves;52% had abnormal head MRI,and frontal lobe lesions were the most common;no children were found to have tumors during hospitalization.An ovarian teratoma was found in a 5+ year old female child 9 months after the illness;(6)In this study,146 children were followed up regularly until at least 6 months after initial immunotherapy,138/146(94.5%)received combined treatment with methylprednisolone and IVIG,23/146(15.8%)received repeated first-line immunotherapy and 15/146(10.3%)received second-line immunotherapy after initial immunotherapy,of which 7/146(4.8%)received both treatments.18/146 children(12.3%)received long-term immunosuppressive therapy(mycophenolate mofetil or azathioprine),7.5% of whom were treated for longer than 1 year;(7)There were 146 children who were followed up to at least 6 months after immunotherapy(range 6-72 months),and 13 cases had 1 to 3 recurrences.In the first 6months,126 cases arrived m RS ≤ 2(86.3%),4 cases died.At the last follow-up,138 cases(94.5%)had a good prognosis(m RS ≤ 2 points).(8)Peak m RS≥5 points,increased cranial MRI RCMM-PMRIS score,and admission to ICU were independent risk factors for poor prognosis at 6months after initial immunotherapy.Conclusion: The mean age of onset of anti-NMDAR encephalitis in children in this study was 7.8±3.6 years and it is more common in girls and has a higher recurrence rate;abnormal psychiatric behavior is the most common symptom;some children overlap with other neuron autoantibodies;most children respond well to immunotherapy and have a good prognosis;peak m RS ≥ 5 points,increased cranial MRI RCMM-PMRIS score,and admission to ICU predict a poor prognosis at 6months after initial immunotherapy. |
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