Department of Neurosciences, University of California San Diego, San Diego, CA, USA; Division of Neurology, Rady Children's Hospital San Diego, San Diego, CA, USA.
Department of Neurosciences, University of California San Diego, San Diego, CA, USA; Division of Neurology, Rady Children's Hospital San Diego, San Diego, CA, USA.
J Affect Disord. 2022 Jul 1;308:449-457. doi: 10.1016/j.jad.2022.04.027. Epub 2022 Apr 13.
Long-term neuropsychiatric sequelae of autoimmune encephalitis (AE) remain understudied, particularly in pediatric-onset AE. We aimed to synthesize the published data on ongoing psychiatric symptoms in pediatric-onset AE.
The Pubmed, PyscINFO, Web of Science databases were searched from their inception years to August 23, 2021, and 29 studies were identified and analyzed. We also performed a quantitative synthesis of available patient data from the 29 studies combined with a cohort of anti-NMDA receptor (NMDAR) AE from our institution to examine the associations between acute treatment course and long-term psychiatric outcome.
At long-term follow up, 52.4% of the cases with pediatric-onset AE had any persistent symptom and 36.0% had at least one psychiatric symptom. Pooled data found that 36.3% of pediatric-onset anti-NMDAR AE had ongoing psychiatric symptoms. Using a univariate logistic regression analysis, we found that abnormal initial EEG, use of certain immunotherapies, and persistent cognitive impairments were associated with ongoing psychiatric symptoms.
Limitations of the existing literature included a significant paucity of outcomes measured using consistent, objective methods. Limitations of the systematic review included the wide variability among the studies reviewed, which rendered a meta-analysis impossible and beyond the scope of the paper.
Chronic psychiatric and behavioral problems remain present in one-third of children months to years after onset of AE. Larger scaled prospective observational studies with a consistent standardized battery of testing are needed to examine impact of specific clinical features and immunotherapies on long-term mental health outcomes.
自身免疫性脑炎（AE）的长期神经精神后遗症仍研究不足，尤其是在儿童发病的 AE 中。我们旨在综合已发表的关于儿童发病的 AE 中持续性精神症状的数据。
从各数据库建立年份至 2021 年 8 月 23 日，检索 Pubmed、PyscINFO、Web of Science 数据库，共确定并分析了 29 项研究。我们还对 29 项研究中可用的患者数据进行了定量综合，并结合我们机构的抗 N-甲基-D-天冬氨酸受体（NMDAR）AE 队列，研究急性治疗过程与长期精神结局之间的关系。
在长期随访中，52.4%的儿童发病 AE 病例存在持续性症状，36.0%存在至少一种精神症状。汇总数据发现，36.3%的儿童发病抗 NMDAR AE 存在持续性精神症状。使用单变量逻辑回归分析，我们发现异常初始脑电图、使用某些免疫疗法和持续的认知障碍与持续性精神症状相关。
现有文献的局限性包括使用一致、客观方法测量的结果显著不足。系统评价的局限性包括所审查的研究差异很大，这使得无法进行荟萃分析，也超出了本文的范围。
AE 发病后数月至数年，三分之一的儿童仍存在慢性精神和行为问题。需要更大规模的前瞻性观察性研究，采用一致的标准化测试组，以检查特定临床特征和免疫疗法对长期心理健康结局的影响。
