| Objective: To summarize the clinical peculiarities of 47 pediatric autoimmune encephalitis(AE),hazard prognostic factors and the effect of antibodies in this disease,so as to present reference for clinical practice.Methods:Children up to 18 years old who were diagnosed as AE by the Department of Pediatrics and Neurology of the First Affiliated Hospital of Nanchang University from January 2015 to October 2022,their ordinary data included gender and age,clinical date included onset form,prodromal symptoms,initial symptoms and symptoms,laboratory test results,brain magnetic resonance imaging,electroencephalography,immunotherapeutic programme,efficacy,length of hospital stay,and whether or not admitted to intensive care unit(ICU)were retrospectively collected.The condition of the children before receiving immunotherapy,when released and at least 6 months postdischarge were assessed by the Modified Rankin Scale(m RS).The characteristics of pediatric AE were analyzed according to the date.The positive rate of serum and CSF antibody,the difference in titer,and their relationship with the severity and prognosis were also assessed in order to explore the value of AErelated antibody detection in diagnosis and treatment.According to the m RS score at the time of follow-up,all enrolled cases were divided into two groups with good or poor prognosis.Comparing the difference between them,then using the binary logistic regression analysis to discover the independent risk prognostic factors.Results:1.Ordinary data:There were 47 cases,23 were males and 24 were females,with a gender ratio of 0.96: 1.12.8±4.2 years old in average,and there was no sexually statistically significant difference(P>0.05).2.Clinical manifestation:34/47 cases(72.3%)had an acute onset,9/47 cases(19.2%)had a subacute onset,4/47 cases(8.5%)had a chronic onset.Prodromal affective symptoms presented in 16/47 cases(34.0%)1-3 weeks before onset,seizure(16/47 cases,34.0%)and Psycho-behavioral disorder(12/47 cases,25.5%)as the most common first symptom,while Psycho-behavioral disorder(61.7%),seizure(53.2%)and consciousness disorder(38.3%)were more common during the course.3.Antibody results:The antibody was positive in 40 patients,containing 21/40(52.5%)anti-NMDAR encephalitis,5/40(12.5%)anti-MOG encephalitis,3/40 antiGABAb and multi-antibody positive autoimmune encephalitis,2/40(5%)anti-DPPX encephalitis and encephalitis with indefinite antibody,1/40(2.5%)anti-GAD65,antiGQ1 b antibody and anti-m Glu R5 encephalitis.4.Antibody value:The sensitivity of CSF antibody(95.2%)among 21 antiNMDAR encephalitis was higher than that of serum antibody(66.7%)(P<0.05).In 5anti-MOG encephalitis patients,CSF antibody positive rate(100.0%)was higher than that of serum antibody(0.0%),remarkably.The initial m RS score was correlated with CSF antibody titer(P<0.05).5.Analysis of prognosis:40/46(87.0%)children had a good prognosis,and 6/46(13.0%)children had a poor prognosis.Early immunotherapy(P<0.05)and admission to ICU(P<0.01)were independent risk factors of the prognosis.Conclusion:1.Most pediatric AE patients onset acutely or subacutely,and in the early stages of the disease,it often manifests as limb twitching or psychobehavioral disorder,consciousness disorders are common during the course.2.Anti-NMDAR encephalitis is the most common type of pediatric AE.CSF antibody’s sensitivity is higher serum in the diagnosis of anti-NMDAR encephalitis,but lower than that of the latter in anti-MOG encephalitis.3.The prognosis is mostly good after immunotherapy,poor prognosis can be predicted by lacking early immunotherapy and admission to ICU independently. |
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