Luo Hanyu, Ding Xiao, Li Yuhang, Ma Jiannan, Liu Benke, Zhou Lvli, Zheng Yaxin, Jiang Yan, Li Xiujuan, Jiang Li
Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Pediatr Neurol. 2022 May;130:46-52. doi: 10.1016/j.pediatrneurol.2022.02.004. Epub 2022 Mar 11.
Viral encephalitis is an important trigger for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. We analyzed the clinical characteristics of anti-NMDAR encephalitis after Japanese encephalitis (JE) in children.
Clinical data of 185 children with anti-NMDAR encephalitis were retrospectively reviewed. Patients with a history of viral encephalitis other than JE or who were identified with other autoantibodies were excluded.
Twenty children with anti-NMDAR encephalitis after JE were enrolled with a median age of 6 years and 10 months (interquartile range [IQR]: 3 years to 11 years and 5 months). The median time from JE to anti-NMDAR encephalitis was 29 (IQR: 25 to 32) days. At 12 months, most patients (17 of 18) recovered to at least their baseline modified Rankin scale (mRS) scores caused by JE. One hundred forty two children with classical anti-NMDAR encephalitis were enrolled. Compared with classical anti-NMDAR encephalitis, patients after JE had significantly more decreased level of consciousness (50% vs 18.3%, P = 0.003), more autonomic dysfunction (30.0% vs 9.9%, P = 0.021), fewer psychiatric or behavioral symptoms (70.0% vs 90.8%, P = 0.016), fewer seizures (25.0% vs 68.3%, P < 0.001), lesser improvement 4 weeks after immunotherapy (35.0% vs 73.2%, P = 0.001), and worse outcomes at 12 months (median mRS: 1 vs 0, P < 0.001).
Anti-NMDAR encephalitis after JE in children mainly occurred within two months. Their clinical manifestation may differ from classical anti-NMDAR encephalitis. The prognosis of children with anti-NMDAR encephalitis after JE probably depends on the neurological sequelae after JE.
病毒性脑炎是抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎的重要触发因素。我们分析了儿童乙型脑炎（JE）后抗NMDAR脑炎的临床特征。
回顾性分析185例抗NMDAR脑炎患儿的临床资料。排除有除JE以外的病毒性脑炎病史或检测出其他自身抗体的患者。
纳入20例JE后抗NMDAR脑炎患儿，中位年龄为6岁10个月（四分位间距[IQR]：3岁至11岁5个月）。从JE到抗NMDAR脑炎的中位时间为29天（IQR：25至32天）。在12个月时，大多数患者（18例中的17例）恢复到至少由JE导致的基线改良Rankin量表（mRS）评分。纳入142例经典抗NMDAR脑炎患儿。与经典抗NMDAR脑炎相比，JE后患儿意识水平下降更明显（50% 对18.3%，P = 0.003），自主神经功能障碍更多（30.0% 对9.9%，P = 0.021），精神或行为症状更少（70.0% 对90.8%，P = 0.016），癫痫发作更少（25.0% 对68.3%，P < 0.001），免疫治疗4周后改善程度更小（35.0% 对73.2%，P = 0.001），12个月时预后更差（中位mRS：1对0，P < 0.001）。
儿童JE后抗NMDAR脑炎主要发生在两个月内。其临床表现可能与经典抗NMDAR脑炎不同。儿童JE后抗NMDAR脑炎的预后可能取决于JE后的神经后遗症。
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