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N-methyl-D-aspartate receptor antibody-mediated neurological disease: results of a UK-based surveillance study in children.

AbstractOBJECTIVE:
N-methyl-D-aspartate receptor antibody (NMDAR-Ab) encephalitis is a well-recognised clinico-immunological syndrome that presents with neuropsychiatric symptoms cognitive decline, movement disorder and seizures. This study reports the clinical features, management and neurological outcomes of paediatric NMDAR-Ab-mediated neurological disease in the UK.
DESIGN:
A prospective surveillance study. Children with NMDAR-Ab-mediated neurological diseases were voluntarily reported to the British Neurological Surveillance Unit (BPNSU) from November 2010 to December 2011. Initial and follow-up questionnaires were sent out to physicians.
RESULTS:
Thirty-one children fulfilled the criteria for the study. Eight presented during the study period giving an incidence of 0.85 per million children per year (95% CI 0.64 to 1.06); 23 cases were historical. Behavioural change and neuropsychiatric features were present in 90% of patients, and seizures and movement disorders both in 67%. Typical NMDAR-Ab encephalitis was reported in 24 children and partial phenotype without encephalopathy in seven, including predominantly psychiatric (four) and movement disorder (three). All patients received steroids, 22 (71%) received intravenous immunoglobulin, 9 (29%) received plasma exchange,and 10 (32%) received second-line immunotherapy. Of the 23 patients who were diagnosed early, 18 (78%) made a full recovery compared with only 1 of 8 (13%) of the late diagnosed patients (p=0.002, Fisher's exact test). Seven patients relapsed, with four needing additional second-line immunotherapy.
CONCLUSIONS:
Paediatric NMDAR-Ab-mediated neurological disease appears to be similar to adult NMDAR-Ab encephalitis, but some presented with a partial phenotype. Early treatment was associated with a quick and often full recovery.
AuthorsSukhvir Wright, Yael Hacohen, Leslie Jacobson, Shakti Agrawal, Rajat Gupta, Sunny Philip, Martin Smith, Ming Lim, Evangeline Wassmer, Angela Vincent
JournalArchives of disease in childhood (Arch Dis Child) Vol. 100 Issue 6 Pg. 521-6 (Jun 2015) ISSN: 1468-2044 [Electronic] England
PMID25637141 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightPublished by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Chemical References
  • Autoantibodies
  • Receptors, N-Methyl-D-Aspartate
Topics
  • Adolescent
  • Autoantibodies (blood)
  • Autoimmune Diseases of the Nervous System (diagnosis, epidemiology, therapy)
  • Child
  • Child, Preschool
  • Encephalitis (diagnosis, epidemiology, therapy)
  • Female
  • Humans
  • Immunotherapy
  • Infant
  • Male
  • Prospective Studies
  • Receptors, N-Methyl-D-Aspartate (immunology)
  • Surveys and Questionnaires
  • United Kingdom (epidemiology)

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