Clinical Features Of Anti-N-methyl-D-aspartate Receptor Encephalitis In Children And Adults And Anti-gamma-aminobutyric Acid Type B Receptor Encephalitis Were Reported In 2 Cases

Objective: At present,so many articles about children with anti-N-methyl-D-aspartate(NMDA)receptor encephalitis and adults have been published both in China and abroad.But large-scale investigations on comparative research between children and adults with anti-NMDA receptor encephalitis are even much fewer.This study is to compare and analyze differences in clinical features,auxiliary examination and immunotherapy between children with anti-NMDA receptor encephalitis and adults,exploring some new understanding on children with anti-NMDA receptor encephalitis and adults.Methods: Clinical data embraced basic information,clinical symptoms and characteristic,accessory examinations,immunological therapy were retrospectively collected from 60 cases anti-NMDA receptor encephalitis enrolled in the study.All people were divided into the child group and the adult according to the age of onset(? 14 years old and ?14 years old).Score ofModified Rankin Scale(mRS)before and after treatment and follow-up period(1month~32 months)were compared to estimate the neurological outcome.Results:1.Data from 60 patients included 33 children and 27 adults were analyzed.There were 16 males and 17 females in the child group,17 males and 10 females in the adult group.Difference in sex between the two groups was not statistically significant.In clinical features,4 cases of pediatric patients and 14 cases of adults had hypoventilation,1 case of pediatric patient and 6 cases of adults developed status epilepticus.Hypoventilation and status epilepticus were more common in the adult group than the child.2.In the routine electroencephalogram(EEG),27 cases of children showed delta brush,3 cases of adults showed,too.The child group was higher than the adult on positive rate of delta brush in EEG.3.In tumor screening,2 women were complicated by suspicious ovarian teratoma,none of children complicated by tumor.4.In immunotherapy,large dose methylprednisolone received by 32 cases of children and 24 cases of adults.31 cases of children and 13 cases of adults received intravenous immune globulin.12 cases of adults received plasma exchange(PE),none of children received plasma exchange.Intravenous immune globulin was used relative commonly to treat the disease in the child group,while the plasma exchange used commonly in the adult group.5.The average time of onset to get admitted to the hospital of children was(14.97±9.82)days,adults was 24 days.The average time of final diagnosis of children was(25.15±14.10)days,adults was(35.19±16.22)days.The disease course of children was(45.42±16.56)days,adults was(67.07±50.66)days.Time of onset to get admitted to the hospital and final diagnosis and the course of disease of the child group were shorter than the adult.9 cases of children were sent to ICU,while the adult group had 15 cases,patients who were sent to ICU in the child group were lesser than the adult.6.The score of mRS before treatment in the child group and the adult were5.The score of mRS after treatment were(2.55±1.50)and(3.33±1.59)respectively in the child group and the adult.The score of mRS of follow-up between the two group were 0.The score of mRS of the child group had no significant difference with the adult.3 cases of adults died,none of the children died at follow-up visit.Conclusion: Compared by children,clinical characteristics is relative complex in adults with anti-NMDA receptor encephalitis,the incidence of hypoventilation and status epilepticus are high,patients are heavier,the course of disease is longer,while the ratio of death and prognosis have no significant difference with children.Objective: To report the diagnosis and treatment of 2 cases of anti-?-aminobutyric acid(B-type)receptor encephalitis(anti-GABAB receptor encephalitis),reviewing relative literatures.Methods: Clinical data was collected from 2 cases of anti-GABAB receptor encephalitis,summarized clinical features,accessory examination,treatment procedure and prognosis.Results: 2 patients were adult.The primary clinical characteristics included epilepsy,memory loss,disorder of consciousness,mental symptoms and illusion.In cerebrospinal fluid(CSF)and serum anti-GABABR-Ig G were positive.No obvious abnormality in cerebrospinal fluid laboratory tests.Electroencephalogram prompted slow wave.Head MRI showed the limbic system abnormal signal including hippocampus,parahippocampal gyrus and amygdala.Lung CT and tumor screening have not found cancer.2 patients were misdiagnosed as viral encephalitis,after treatment with antiviral,hormones,intravenous immune globulin,symptoms took a turn for the better.Conclusion: Anti-GABAB receptor encephalitis should combine with clinical manifestations and CSF autoimmune related antibodies to diagnose,head MRI is helpful,early positive immunomodulatory therapy,prognosis can be ideal.