Department of Neuropsychology, Children's Healthcare of Atlanta, Emory University School of Medicine, USA.
Department of Pediatrics, Division of Pediatric Neurology, Emory University School of Medicine and Children's Healthcare of Atlanta, 1400 Tulle Road NE, 8(th) Floor, Atlanta, GA 30329, USA.
J Neuroimmunol. 2023 Mar 15;376:578048. doi: 10.1016/j.jneuroim.2023.578048. Epub 2023 Feb 8.
Anti-NMDA receptor autoimmune encephalitis (NMDARE) is a common pediatric encephalitis, resulting in neuropsychiatric symptoms. Predicting severity and course is challenging, with objective cognitive assessments lacking in NMDARE, especially in children. The CASE (Clinical Assessment Scale in Autoimmune Encephalitis) measures severity in autoimmune encephalitis. The CALS (Cognitive and Linguistic Scale) assesses cognitive-linguistic recovery in children with acquired brain injury. This study examines severity and cognitive status in pediatric NMDARE by comparing objectives measures: modified Rankin score (mRS), CASE, and CALS.
Twenty-one patients were identified via retrospective chart review with a confirmed NMDARE diagnosis (ages of 3-18 years) who required inpatient rehabilitation. The mRS, CASE, and CALS were assessed at admission and discharge.
Scores demonstrated improvement from admission to discharge, with variability in individual recovery trajectories. CALS identified three clusters of patients with differential rates of early recovery. CALS <30 was associated with minimal improvement and poor outcomes. CALS ≥30 had a likelihood ratio score of 12.0 to predict improvement. CASE and CALS were moderately correlated, but neither correlated with mRS.
CALS and CASE appear to be complementary measures for assessing severity and cognitive status in pediatric NMDARE, including those with low responsiveness, with implications for treatment and outcomes.
抗 N- 甲基-D- 天冬氨酸受体自身免疫性脑炎（NMDARE）是一种常见的小儿脑炎，可导致神经精神症状。预测严重程度和病程具有挑战性，NMDARE 缺乏客观认知评估，尤其是在儿童中。CASE（自身免疫性脑炎临床评估量表）测量自身免疫性脑炎的严重程度。CALS（认知和语言量表）评估获得性脑损伤儿童的认知语言恢复情况。本研究通过比较客观测量值来检查儿科 NMDARE 的严重程度和认知状况：改良 Rankin 评分（mRS）、CASE 和 CALS。
通过回顾性病历审查确定了 21 名 NMDARE 确诊（年龄 3-18 岁）并需要住院康复的患者。入院和出院时评估 mRS、CASE 和 CALS。
评分显示从入院到出院有所改善，个体恢复轨迹存在差异。CALS 确定了三组具有不同早期恢复率的患者。CALS <30 与改善最小和预后不良相关。CALS ≥30 的似然比评分预测改善的可能性为 12.0。CASE 和 CALS 呈中度相关，但与 mRS 均不相关。
CALS 和 CASE 似乎是评估儿科 NMDARE 严重程度和认知状况的补充措施，包括那些反应能力较低的患者，这对治疗和结果有影响。
