儿童自身免疫性脑炎合并运动障碍的临床特征及预后分析：一项单中心回顾性研究

doi:10.12372/jcp.2026.25e0962

Abstract

Abstract:

Objective Movement disorders are not uncommon clinical manifestations in children with autoimmune encephalitis (AE). The characteristics of movement disorders in children with AE and their impact on the clinical prognosis of AE remain to be systematically clarified. This study aims to investigate these issues through a systematic review of patients accumulated over 10 years in a single center. Methods A retrospective analysis was conducted on the data of 82 children diagnosed with AE from January 2014 to December 2023. Information on their general conditions, clinical manifestations, laboratory tests, treatments, and prognoses was collected. The modified Rankin Scale (mRS) was used to assess the severity of the disease, and differences between different age groups were compared. Results The median age of onset was 9 (1.2 - 17) years, and 46.3% were positive for anti-neuronal antibodies, with anti-NMDAR encephalitis accounting for 39.0%. The most common symptoms were behavioral abnormalities, movement disorders, and epileptic seizures. The incidence of movement disorders was 68.3%, mainly characterized by stereotyped movements and orofacial movement disorders. The incidence of movement disorders was higher in children with anti-NMDAR encephalitis (81.3%). Age stratification showed that movement disorders were more common in the <12-year-old group (P<0.05), and orofacial movement disorders were particularly prominent in this group (P=0.027), and were only observed in children with anti-NMDAR encephalitis in this group (P=0.004). The proportion of autonomic dysfunction, sleep disorders, anti-NMDAR antibody positivity, and mRS scores in the movement disorder group were all higher than those in the non-movement disorder group (P<0.05). The overall good prognosis rate was 70.7%, and the recurrence rate was 11.0%. Except for the mRS score at discharge being higher in the movement disorder group than in the non-movement disorder group (P=0.027), no differences were observed in other long-term prognosis indicators between the two groups. Conclusion The antibody positivity rate in children with AE is less than 50%, and the clinical manifestations are mainly behavioral abnormalities, movement disorders, and epileptic seizures. Movement disorders are more common in children under 12 years old and those with anti-NMDAR encephalitis. Patients with autonomic dysfunction and sleep disorders are more likely to have movement disorders. Movement disorders are not a risk factor for poor prognosis in children with AE.

Key words: autoimmune encephalitis, anti-NMDAR encephalitis, movement disorders, child

CLC Number:

SHI Yongyuan, YANG Lijuan, LEI Wenting, XIONG Yurong, PAN Shujing, LI Yuelin, ZHANG Jiali, TIAN Maoqiang. Clinical characteristics and prognosis analysis of autoimmune encephalitis with movement disorders in children: A single-center retrospective study[J].Journal of Clinical Pediatrics, 2026, 44(6): 532-539.

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References 33

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项目	运动障碍组（n=56）	无运动障碍组（n=26）	统计量	P
年龄[M(P₂₅~P₇₅)]/岁	8(4~11)	12.5(4~14.5)	Z=1.78	0.075
男性[n(%)]	25(44.6)	14(53.8)	χ²=0.60	0.437
住院时长[M(P₂₅~P₇₅)]/d	20.00(14.00~26.5)	17.5(12.75~22.25)	Z=1.42	0.155
急性或亚急性起病[n(%)]	53(94.6)	25(96.2)	χ²=0.00	1.000
呕吐[n(%)]	2(3.6)	0(0.0)	-	1.000^1）
头晕/头痛[n(%)]	4(7.1)	6(23.1)	χ²=2.85	0.091
精神行为异常[n(%)]	41(73.2)	16(61.5)	χ²=1.14	0.285
认知障碍[n(%)]	17(30.4)	4(15.4)	χ²=2.09	0.148
记忆障碍[n(%)]	8(14.3)	6(23.1)	χ²=0.45	0.503
癫痫发作[n(%)]	35(62.5)	18(69.2)	χ²=0.35	0.553
癫痫持续状态[n(%)]	9(16.1)	3(11.5)	χ²=0.04	0.838
语言障碍[n(%)]	18(32.1)	4(15.4)	χ²=2.54	0.111
意识障碍[n(%)]	15(26.8)	4(15.4)	χ²=1.30	0.255
自主神经功能障碍[n(%)]	20(35.7)	3(11.5)	χ²=5.14	0.023
睡眠障碍[n(%)]	35(62.5)	10(38.5)	χ²=4.14	0.042
阳性体征[n(%)]	12(21.4)	3(11.5)	χ²=0.60	0.441
并发症[M(P₂₅~P₇₅)]/个	1(0~3)	1(0~2)	Z=0.32	0.749
治疗前mRS评分[M(P₂₅~P₇₅)]	4(3~4.75)	3(3~4.25)	Z=2.25	0.025

项目	运动障碍组（n=56）	无运动障碍组（n=26）	统计量	P
外周血白细胞[M(P₂₅~P₇₅)]/×10⁹·L^-1	8.47(6.20~11.33)	6.85(5.69~10.69)	Z=1.11	0.267
外周血血红蛋白（ x±s）/g·L^-1	122.70±15.34	122.38±13.18	t=0.09	0.929
外周血血小板（ x±s）/×10⁹·L^-1	322.88±118.59	326.27±109.24	t=0.12	0.902
外周血中性粒细胞[M(P₂₅~P₇₅)]/×10⁹·L^-1	5.24(3.92~7.97)	4.74(3.10~7.20)	Z=1.04	0.298
外周血淋巴细胞[M(P₂₅~P₇₅)]/×10⁹·L^-1	1.93(1.45~2.91)	1.94(0.96~2.44)	Z=1.12	0.262
血钾（ x±s）/mmol·L^-1	4.14±0.46	4.14±0.52	t=0.05	0.961
血钠（ x±s）/mmol·L^-1	137.49±2.64	136.94±3.10	t=0.84	0.404
丙氨酸氨基转移酶[M(P₂₅~P₇₅)]/U·L^-1	16.50(12.00~30.25)	19.00(9.75~28.50)	Z=0.39	0.694
肌酸激酶同工酶[M(P₂₅~P₇₅)]/U·L^-1	19.0(14.00~24.00)	19.0(15.00~22.00)	Z=0.37	0.712
脑脊液压力≥200 mmH₂O[n(%)]	13(23.2)	8(30.8)	χ²=0.53	0.466
脑脊液白细胞[M(P₂₅~P₇₅)]/×10⁶·L^-1	11.00(1.25~32.75)	8.00(2.00~14.75)	Z=0.74	0.457
脑脊液蛋白质[M(P₂₅~P₇₅)]/mg·L^-1	295.50(198.00~365.75)	295.50(244.00~397.50)	Z=0.52	0.517
脑脊液葡萄糖（ x±s）/mmol·L^-1	3.62±0.54	3.96±0.62	t=2.55	0.013
脑脊液氯化物（ x±s）/mmol·L^-1	125.85±4.03	125.82±2.91	t=0.03	0.977
抗NMDAR抗体阳性[n(%)]	26(46.4)	6(23.1)	χ²=4.07	0.044
头颅MRI异常[n(%)]	27(48.2)	11(42.3)	χ²=0.25	0.618
脑电图异常[n(%)]	45(80.4)	22(84.6)	χ²=0.03	0.875

项目	运动障碍组（n=56）	无运动障碍组（n=26）	统计量	P
免疫延迟治疗[n(%)]	10(17.9)	4(15.4)	χ²=0.00	1.000
二线治疗[n(%)]	9(16.1)	3(11.5)	χ²=0.04	0.838
气管插管[n(%)]	7(12.5)	8(30.8)	χ²=2.84	0.092
出院时mRS评分[M(P₂₅~P₇₅)]	2.00(1.00~3.75)	1.00(1.00~2.00)	Z=2.21	0.027
随访时mRS评分[M(P₂₅~P₇₅)]	0.00(0.00~2.00)	0.00(0.00~2.00)	Z=0.31	0.757
预后不良[n(%)]	16(28.6)	8(30.8)	χ²=0.04	0.839
复发[n(%)]	7(12.5)	2(7.7)	χ²=0.07	0.788

Clinical characteristics and prognosis analysis of autoimmune encephalitis with movement disorders in children: A single-center retrospective study

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