Clinical Characteristics of Children With Anti-N-Methyl-d-Aspartate Receptor Encephalitis After Japanese Encephalitis.

Abstract

BACKGROUND:

Viral encephalitis is an important trigger for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. We analyzed the clinical characteristics of anti-NMDAR encephalitis after Japanese encephalitis (JE) in children.

METHODS:

Clinical data of 185 children with anti-NMDAR encephalitis were retrospectively reviewed. Patients with a history of viral encephalitis other than JE or who were identified with other autoantibodies were excluded.

RESULTS:

Twenty children with anti-NMDAR encephalitis after JE were enrolled with a median age of 6 years and 10 months (interquartile range [IQR]: 3 years to 11 years and 5 months). The median time from JE to anti-NMDAR encephalitis was 29 (IQR: 25 to 32) days. At 12 months, most patients (17 of 18) recovered to at least their baseline modified Rankin scale (mRS) scores caused by JE. One hundred forty two children with classical anti-NMDAR encephalitis were enrolled. Compared with classical anti-NMDAR encephalitis, patients after JE had significantly more decreased level of consciousness (50% vs 18.3%, P = 0.003), more autonomic dysfunction (30.0% vs 9.9%, P = 0.021), fewer psychiatric or behavioral symptoms (70.0% vs 90.8%, P = 0.016), fewer seizures (25.0% vs 68.3%, P < 0.001), lesser improvement 4 weeks after immunotherapy (35.0% vs 73.2%, P = 0.001), and worse outcomes at 12 months (median mRS: 1 vs 0, P < 0.001).

CONCLUSIONS:

Anti-NMDAR encephalitis after JE in children mainly occurred within two months. Their clinical manifestation may differ from classical anti-NMDAR encephalitis. The prognosis of children with anti-NMDAR encephalitis after JE probably depends on the neurological sequelae after JE.

• Authors: Hanyu Luo, Xiao Ding, Yuhang Li, Jiannan Ma, Benke Liu, Lvli Zhou, Yaxin Zheng, Yan Jiang, Xiujuan Li, Li Jiang
• Journal: Pediatric neurology (Pediatr Neurol) Vol. 130 Pg. 46-52 (05 2022) ISSN: 1873-5150 [Electronic] United States
• PMID: 35325660 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Chemical References

• Autoantibodies
• Receptors, N-Methyl-D-Aspartate

Topics

• Anti-N-Methyl-D-Aspartate Receptor Encephalitis (complications)
• Autoantibodies
• Child
• Child, Preschool
• Encephalitis, Japanese (complications)
• Encephalitis, Viral (complications)
• Humans
• Receptors, N-Methyl-D-Aspartate
• Retrospective Studies