Original Article

Analysis of prodromal events in pediatric patients with anti-N-methyl-D-aspartate receptor encephalitis

  • Wenlin WU ,
  • Chi HOU ,
  • Kelu ZHENG ,
  • Yani ZHANG ,
  • Yiru ZENG ,
  • Lianfeng CHEN ,
  • Haixia ZHU ,
  • Yang TIAN ,
  • Bingwei PENG ,
  • Xiuying WANG ,
  • Yinting LIAO ,
  • Wenxiong CHEN ,
  • Xiaojing LI
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  • Department of Neurology, Guangzhou Women and Children’s Medical Center, Guangzhou 510120, Guangdong, China

Received date: 2023-10-20

  Online published: 2024-11-08

Abstract

Objective To analyze the correlation between anti N-methyl-D-aspartate receptor (NMDAR) encephalitis prodromal events and clinical features in children. Methods A retrospective analysis was conducted on 107 pediatric patients with anti-NMDAR encephalitis from January 2014 to March 2019, to examine the correlation between prodromal events and clinical characteristics in these children. Results Of the 107 patients, 52 cases (48.6%) had prodromal events, predominantly consisting of infectious prodromal events (73.1%, 38 out of 52). A comparative analysis revealed that patients with a history of intracranial infection as a prodromal event were significantly younger at onset (6.0±4.7 years) compared to those without such a history (6.4±2.9 years, P=0.006). Additionally, these patients had a markedly higher incidence of limb paralysis (P=0.038) and sleep disorders (P=0.037). The hospital stay was prolonged for patients with intracranial infection prodromal events (P=0.001). Furthermore, these patients exhibited higher modified Rankin Scale (mRS) scores prior to treatment (P=0.008) and required more courses of intravenous immunoglobulin (IVIG) treatment (P=0.011). Conclusions Pediatric patients with anti-NMDAR encephalitis and prodromal events, particularly those with intracranial infections, displayed distinct clinical profiles. They were more likely to present at an earlier age with increased rates of limb paralysis and sleep disorders, necessitating longer hospital stays and additional IVIG treatments.

Cite this article

Wenlin WU , Chi HOU , Kelu ZHENG , Yani ZHANG , Yiru ZENG , Lianfeng CHEN , Haixia ZHU , Yang TIAN , Bingwei PENG , Xiuying WANG , Yinting LIAO , Wenxiong CHEN , Xiaojing LI . Analysis of prodromal events in pediatric patients with anti-N-methyl-D-aspartate receptor encephalitis[J]. Journal of Clinical Pediatrics, 2024 , 42(11) : 912 -916 . DOI: 10.12372/jcp.2024.23e1027

References

[1] 中华医学会神经病学分会神经感染性疾病与脑脊液细胞学学组. 中国自身免疫性脑炎诊治专家共识(2022年版)[J]. 中华神经科杂志, 2022, 55(9): 931-949.
[2] Jiang Y, Dai S, Jia L, et al. Single-cell transcriptomics reveals cell type-specific immune regulation associated with anti-NMDA receptor encephalitis in humans[J]. Front Immunol, 2022, 13: 1075675.
[3] Sun B, Ramberger M, O'Connor KC, et al. The B cell immunobiology that underlies CNS autoantibody-mediated diseases[J]. Nat Rev Neurol, 2020, 16(9): 481-492.
[4] Wang Y, Zhang W, Yin J, et al. Anti-N-methyl-D-aspartate receptor encephalitis in children of Central South China: Clinical features, treatment, influencing factors, and outcomes[J]. J Neuroimmunol, 2017, 312: 59-65.
[5] Li X, Hou C, Wu WL, et al. Pediatric anti-N-methyl-D-aspartate receptor encephalitis in southern China: Analysis of 111 cases[J]. J Neuroimmunol, 2021, 352: 577479.
[6] Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis[J]. Lancet Neurol, 2011, 10(1): 63-74.
[7] Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis[J]. Lancet Neurol, 2016, 15(4): 391-404.
[8] Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study[J]. Lancet Neurol, 2013, 12(2): 157-165.
[9] Wang W, Li JM, Hu FY, et al. Anti-NMDA receptor encephalitis: clinical characteristics, predictors of outcome and the knowledge gap in southwest China[J]. Eur J Neurol, 2016, 23(3): 621-629.
[10] Huang Q, Wu Y, Qin R, et al. Clinical characteristics and outcomes between children and adults with anti-N-Methyl-D-Aspartate receptor encephalitis[J]. J Neurol, 2016, 263(12): 2446-2455.
[11] Armangue T, Spatola M, Vlagea A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis[J]. Lancet Neurol, 2018, 17(9): 760-772.
[12] Favier M, Joubert B, Picard G, et al. Initial clinical presentation of young children with N-methyl-D-aspartate receptor encephalitis[J]. Eur J Paediatr Neurol, 2018, 22(3): 404-411.
[13] Ho AC, Chan SH, Chan E, et al. Anti-N-methyl-D-aspartate receptor encephalitis in children: Incidence and experience in Hong Kong[J]. Brain Dev, 2018, 40(6): 473-479.
[14] Lee SH, Atiya N, Wang SM, et al. Loss of transfected human brain micro-vascular endothelial cell integrity during herpes simplex virus infection[J]. Intervirology, 2018, 61(4): 193-203.
[15] Dalmau J. NMDA receptor encephalitis and other antibody-mediated disorders of the synapse: The 2016 Cotzias Lecture[J]. Neurology, 2016, 87(23): 2471-2482.
[16] Stahl JP, Mailles A. Herpes simplex virus encephalitis update[J]. Curr Opin Infect Dis, 2019, 32(3): 239-243.
[17] Wang H. A protocol for investigating the association of vaccination and anti-NMDA receptor encephalitis[J]. Front Biosci (Schol Ed), 2018, 10(2): 229-237.
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