Retrospective Analysis Of Clinical Characteristics Of 61 Cases Of Autoimmune Encephalitis In Children

Objective:Autoimmune encephalitis is a class of inflammatory encephalopathy mediated by the patient’s own immune mechanisms.With the continuous improvement of medical conditions,there are more and more patients with autoimmune encephalitis in children.But at present,there is still a lack of guidelines or expert consensus for children with autoimmune encephalitis at home and abroad.The purpose of this thesis is to analyze the basic information,clinical manifestations,auxiliary examinations,treatments and prognoses of children with autoimmune encephalitis admitted to our hospital.To analyze its possible internal relationship and related risk factors affecting prognoses,so as to provide some reference for clinicians in the diagnosis and treatment of autoimmune encephalitis in children.Methods:The basic information,clinical manifestations,auxiliary examinations,treatments and prognoses of 61 children diagnosed with antibody-positive autoimmune encephalitis who were admitted to the Department of Pediatrics of The First People’s Hospital of Yunnan Province and the Department of General Medicine of Kunming Children’s Hospital from January 2017 to January 2022 were collected.According to the test results of autoimmune encephalitis antibody in children,they were divided into: antiN-methyl-D-aspartate receptor encephalitis and other autoimmune encephalitis(other AE).IBM SPSS statistics 26.0 software was used for statistical analysis of relevant data.Results:1.Basic InformationAmong the 61 patients,there were 25 males(41.0%)and 36 females(59.0%),with a male-to-female ratio of 1:1.44.The average age of onset was 9.25±3.20 years old(the minimum was 1 year old and the maximum was 16 years old).The high risk ages was 7-12 years.The average hospital stay was 27.02 days.2.Classification of autoimmune encephalitisGroup 1(anti-N-methyl-D-aspartate receptor encephalitis): 35 cases,including 35 cases of anti-N-methyl-D-aspartate receptor encephalitis;Group 2(other autoimmune encephalitis): 26 cases,including 5 cases of anti-contactin-associated protein-like 2antibody-associated autoimmune encephalitis,5 case of anti-MOG antibody-associated encephalitis,1 case of MOG antibody disease and anti-NMDAR encephalitis overlapping syndrome,15 cases of limbic encephalitis.3.Clinical manifestationProdromal symptoms:23/61 cases(37.7%)had fever,17/61 cases(28.0%)had headache,6/61 cases(9.8%)had vomiting and abdominal pain,and 27/61 cases(44.2%)had no obvious prodromal symptoms;First symptoms:seizures and psychiatric symptom were the most common,30/61 cases(49.2%)and 23/61 cases(37.7%)respectively;During the course of the disease,40/61 cases(65.5%)had psychiatric symptom,mainly behavioral abnormalities,a total of 28/40 cases(70.0%).42/61 cases(68.8%)had epileptic seizures,including 36/42 cases(85.7%)with generalized seizures and 6/42 cases(14.3%)with focal seizures.24/61 cases(39.3%)had movement disorders,mainly dystonia,a total of17/24 cases(70.8%).41/61 cases(67.2%)had autonomic dysfunction,mainly headache,a total of 35/41 cases(85.4%).23/61 cases(37.7%)had disturbed sleep.28/61 cases(45.9%)had altered level of consciousness.22/61 cases(36.1%)had cognitive dysfunction,mainly speech disorder,a total of 11/22 cases(50.0%).4.Auxiliary examinationsAll 61 children underwent lumbar puncture,30/61 cases(49.2%)had increased number of cerebrospinal fluid cells,mainly lymphocytes;22/61 cases(36.1%)had increased protein quantification in CSF.50/61 patients(82.0%)had abnormal EEG,which was mainly manifested as non-specific background rhythm slowing down;10/61(16.4%)had "extreme delta Brush".46/50(75.4%)had abnormal cranial MRI results.5.TreatmentsAll 61 children received first-line treatment(methylprednisolone,IVIG 2g / kg,plasma exchange),of which 48/61(78.9%)were treated with methylprednisolone pulse combined with IVIG,5/61(8.2%)were treated with methylprednisolone pulse alone,and8/61(13.1%)were treated with IVIG alone.Seven of the 61 children received secondline treatment(rituximab,mycophenolate mofetil).6.PrognosesThe prognosis was assessed by modified Rankin Scale(m RS).The prognosis was good in 44/61 patients(72.1%)with m RS score < 3;a total of 17/61 patients(27.9%)had poor prognosis(MRS ≥ 3).Conclusions:1.The age group with high incidence of autoimmune encephalitis in children is schoolage children and adolescence.The clinical manifestations of AE in children are diverse,and the first symptoms are mainly epileptic seizures and psychiatric symptom.2.Anti-N-methyl-D-aspartate receptor encephalitis is the most common type of antibodypositive AE in children.The changes of CSF routine examination,immunoglobulin detection and cranial MRI in children with various types of AE were non-specific.EEG is essential for the diagnosis of autoimmune encephalitis in children.Abnormal EEG changes are mostly manifested as non-specific background rhythm slowing.3.Most children with AE have a good prognosis after regular treatment.Among the factors affecting the prognosis of children,the time of starting first-line treatment and the severity of disease during hospitalization have a certain relationship with the prognosis of children.The earlier the first-line treatment is started,the better the prognosis of the children.