Naslov
Pediatric anti-n-methyl-d-aspartate receptor encephalitis: case series

Autori
Krajcar, Nina ; Stemberger Marić, Lorna ; Roglić, Srđan ; Tešović, Goran

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, neobjavljeni rad, ostalo

Skup
37​th Annual Meeting of the European Society for Paediatric Infectious Diseases

Mjesto i datum
Ljubljana, Slovenija, 06.05.2019. - 11.05.2019

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
anti‐NMDAR encephalitis ; children

Sažetak
Background Anti–N‐methyl‐D‐aspartate receptor (anti‐ NMDAR) encephalitis is a severe form of encephalitis with specific neurological features that is increasingly recognized in children and adolescents worldwide. In the pediatric population symptoms are similar to those in adults, but seizures, behavioral changes and movement disorders are more prominent and occurrence of underlying tumor is lower. We describe clinical features and treatment outcomes of seven children with anti‐NMDAR encephalitis treated at University Hospital for Infectious Diseases in Zagreb. Case Presentation Summary A total of 7 children were treated between September 2012 and September 2018. The median age was 9 years and 8 months (range 10 months-17 years) ; 5 of them were female. All cases presented with seizures, depressed level of consciousness and movement disorder ; insomnia was observed in 85% ; behavioural changes, memory deficits and hallucinations in 71% ; autonomic instability and language dysfunction in 57% of cases. The diagnosis was confirmed by positive anti-NMDAR antibodies (serum and CSF). Three patients required mechanical ventilation (duration 4-14 days). No patient had a tumor. One infant had a biphasic disease with HSV encephalitis followed by NMDAR encephalitis (22 days after). Although one patient had clinical improvement after corticosteroids, others (after initial immunoglobulins/total plasma exchange therapy) were treated with second-line therapies: cyclophosphamide (n=5) and rituximab (n=2). All children had substantial recovery ; relapses were not observed. Learning Points/Discussion Our case series outlines common clinical features of pediatric anti‐NMDAR encephalitis. Good clinical outcomes were observed in all children after first or second-line treatment ; full recovery with only minor deficits were present in more than half of the cases. This disorder is likely under-recognized and should be suspected in children with neuropsychiatric deficits because early recognition and prompt treatment are essential to obtain full recovery in these patients.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA