Tarantino Samuela, Averna Roberto, Ruscitto Claudia, Ursitti Fabiana, Ferilli Michela Ada Noris, Moavero Romina, Papetti Laura, Proietti Checchi Martina, Sforza Giorgia, Balestri Martina, Grimaldi Capitello Teresa, Vigevano Federico, Vicari Stefano, Valeriani Massimiliano
Unit of Clinical Psychology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Child and Adolescence Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Brain Sci. 2021 Oct 22;11(11):1387. doi: 10.3390/brainsci11111387.
Anti--methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a rare autoimmune illness characterized by a constellation of often severe, but treatable, psychiatric and neurological symptoms. Whereas symptoms such as psychosis and bizarre and abnormal motor behavior are common in adults, pediatric patients typically present with behavioral changes, irritability and sleep dysfunction. The recovery phase is usually slow and may be associated with longstanding adaptive, behavioral and neuropsychological problems. Very few studies explored the cognitive and adaptive sequelae in children with anti-NMDAR encephalitis. The present review article suggests that, although most children and adolescents return to their daily life and previous activities, they may have a low quality of life and show neuropsychological sequelae involving language, memory, especially verbal memory, and attentional resources, even after several months from the hospital discharge. In particular, the available results reveal difficulties in cognitive skills involving executive functions. This impairment is considered the "core" of the cognitive profile of young patients with anti-NMDAR encephalitis. On the other hand, some cognitive skills, such as general intelligence, show good overall recovery over time. Additional neuropsychological research evaluating larger samples, more homogenous methods and longitudinal studies is required.
抗 N-甲基-D-天冬氨酸受体（抗 NMDAR）脑炎是一种罕见的自身免疫性疾病，其特征是一系列通常较为严重但可治疗的精神和神经症状。虽然精神病以及怪异和异常的运动行为等症状在成人中很常见，但儿科患者通常表现为行为改变、易怒和睡眠功能障碍。恢复期通常较慢，可能与长期的适应性、行为和神经心理问题有关。很少有研究探讨抗 NMDAR 脑炎患儿的认知和适应性后遗症。本综述文章表明，尽管大多数儿童和青少年恢复了日常生活和以前的活动，但即使在出院数月后，他们的生活质量可能较低，并表现出涉及语言、记忆尤其是言语记忆以及注意力资源的神经心理后遗症。特别是，现有结果显示涉及执行功能的认知技能存在困难。这种损害被认为是抗 NMDAR 脑炎年轻患者认知特征的“核心”。另一方面，一些认知技能，如一般智力，随着时间的推移显示出良好的总体恢复。需要更多的神经心理学研究来评估更大的样本、更统一的方法和纵向研究。
