Bravo-Oro Antonio, Abud-Mendoza Carlos, Quezada-Corona Arturo, Dalmau Josep, Campos-Guevara Verónica
Hospital Central Doctor Ignacio Morones Prieto, San Luis de Potosi, Mexico.
Rev Neurol. 2013 Nov 1;57(9):405-10.
INTRODUCTION. Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a condition that is increasingly more frequently diagnosed in the paediatric age. Unlike adults, in many cases it is not associated to tumours and the most common initial manifestations in children are seizures and movement disorders, while in adults there is a predominance of psychiatric alterations. CASE REPORTS. We present six confirmed paediatric cases with antibodies against the subunit NR1 of the NMDA receptor in serum and cerebrospinal fluid. Five of the cases began with seizures as the initial clinical symptom prior to the development of the classical clinical features of this condition. In all cases, steroids were used as the first line of treatment, although these only brought about control over the manifestations in one of them; the other patients therefore required second-line immunomodulators. All the patients received methotrexate as immunomodulator treatment to prevent relapses, and in all cases there was an improvement in the patients' situation. CONCLUSIONS. In our series of patients with anti-NMDA receptor encephalitis, none were associated with tumours. All of them were given methotrexate for at least one year and no adverse clinical or analytical events were observed; likewise, there were no neurological sequelae or relapses during treatment. Although it is a small series and it would be advisable to increase the number and time to progression, we see methotrexate as an excellent alternative immunomodulator treatment for this pathology.
引言。抗N-甲基-D-天冬氨酸（NMDA）受体脑炎是一种在儿童期诊断越来越频繁的疾病。与成人不同，在许多情况下它与肿瘤无关，儿童最常见的初始表现是癫痫发作和运动障碍，而在成人中则以精神改变为主。病例报告。我们报告6例确诊的儿童病例，其血清和脑脊液中存在抗NMDA受体亚基NR1的抗体。其中5例在出现该疾病的典型临床特征之前，最初的临床症状为癫痫发作。在所有病例中，均将类固醇作为一线治疗药物，尽管只有1例通过类固醇控制了症状；其他患者因此需要二线免疫调节剂。所有患者均接受甲氨蝶呤作为免疫调节治疗以预防复发，所有患者的病情均有改善。结论。在我们的抗NMDA受体脑炎患者系列中，无一例与肿瘤相关。所有患者均接受了至少一年的甲氨蝶呤治疗，未观察到不良临床或分析事件；同样，治疗期间也未出现神经后遗症或复发。尽管这是一个小样本系列，增加病例数量和随访时间会更理想，但我们认为甲氨蝶呤是这种疾病一种出色的免疫调节替代治疗药物。
