警惕儿童自身免疫性脑炎诊治陷阱

doi:10.12372/jcp.2023.23e0455

Abstract

Abstract:

Over the past 15 years, the development of antibody detection technology led to the increased awareness of autoimmune encephalitis. However, the innovation has also brought about a certain proportion of misdiagnosis, and some patients have been treated improperly as a result. The main reasons for misdiagnosis include lax implementation of diagnostic criteria, incorrect interpretation of antibody test results, and insufficient differential diagnosis. Compared with adults, the symptoms of children with autoimmune encephalitis are more difficult to identify, and there are antibody spectrum and characteristics that are different from those of adults. The differential diagnosis of the disease involves a wider range, and its diagnosis and treatment face greater challenges. This article will summarize the diagnosis and treatment process of autoimmune encephalitis in children based on the current situation in China. The related pitfalls of diagnosis and treatment are interpreted and analyzed in order to help pediatricians improve accurate diagnosis and treatment of autoimmune encephalitis.

Key words: autoimmune encephalitis, diagnosis, therapy, child

ZHANG Weihua, ZOU Liping, REN Haitao, GUAN Hongzhi. Beware of the pitfalls in diagnosis and treatment of autoimmune encephalitis in children[J].Journal of Clinical Pediatrics, 2023, 41(9): 644-649.

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References 22

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广义免疫机制相关CNS炎症	①系统性疾病CNS受累：如SLE、BD
	②感染相关急性脑病
	③发热感染相关癫痫综合征（FIRES）
	④CNS血管炎（原发、继发）
	⑤CNS炎性脱髓鞘疾病
中枢神经系统感染	①病毒：HSV1/2、VZV、CMV
	②其他：细菌、支原体、结核、真菌
遗传	①炎症：自身炎症性疾病（AGS、DADA2），家族性噬血细胞综合征
	②代谢：高氨血症、甲基丙二酸血症合并高同型半胱氨酸血症、卟啉病、线粒体病等
	③离子通道病：ATP1A2、ATP1A3、CACNA1A等
营养或中毒	①药物或毒物：甲硝唑、环孢素、精神类药物、毒品等
	②维生素缺乏：韦尼克脑病、维生素B₁₂缺乏等
其他	①精神类疾病：精神分裂症、癔症、双相情感障碍、孤独症等
	②肿瘤：脑膜癌、胶质瘤、生殖细胞瘤等
	③儿童虐待

Beware of the pitfalls in diagnosis and treatment of autoimmune encephalitis in children

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