Song Li-Fang, Wang Li, Tang Zhi-Hui, Xian Yi-Xin, Liu Kai, Ma Yuan-Ning
Department of Neurology, Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital, Zhengzhou 450053, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2023 Mar 15;25(3):302-307. doi: 10.7499/j.issn.1008-8830.2211082.
To study the clinical features of children with autoimmune encephalitis (AE) secondary to epidemic encephalitis B (EEB).
A retrospective analysis was performed on the medical data of five children with EEB with "bipolar course" who were treated in Children's Hospital Affiliated to Zhengzhou University from January 2020 to June 2022.
Among the five children, there were three boys and two girls, with a median age of onset of 7 years (range 3 years 9 months to 12 years) and a median time of 32 (range 25-37) days from the onset of EEB to the appearance of AE symptoms. The main symptoms in the AE stage included dyskinesia (5/5), low-grade fever (4/5), mental and behavioral disorders (4/5), convulsion (2/5), severe disturbance of consciousness (2/5), and limb weakness (1/5). Compared with the results of cranial MRI in the acute phase of EEB, the lesions were enlarged in 3 children and unchanged in 2 children showed on cranial MRI in the AE stage. In the AE stage, four children were positive for anti-N-methyl-D-aspartate receptor antibody (one was also positive for anti-γ-aminobutyric acid type B receptor antibody), and one was negative for all AE antibodies. All five children in the AE stage responded to immunotherapy and were followed up for 3 months, among whom one almost recovered and four still had neurological dysfunction.
EEB can induce AE, with anti-N-methyl-D-aspartate receptor encephalitis as the most common disease. The symptoms in the AE stage are similar to those of classical anti-N-methyl-D-aspartate receptor encephalitis. Immunotherapy is effective for children with AE secondary to EEB, and the prognosis might be related to neurological dysfunction in the acute phase of EEB.
研究乙型流行性脑炎（乙脑）继发自身免疫性脑炎（AE）患儿的临床特征。
对2020年1月至2022年6月在郑州大学附属儿童医院接受治疗的5例具有“双相病程”的乙脑患儿的病历资料进行回顾性分析。
5例患儿中，男3例，女2例，发病年龄中位数为7岁（范围3岁9个月至12岁），从乙脑发病到出现AE症状的时间中位数为32天（范围25 - 37天）。AE阶段的主要症状包括运动障碍（5/5）、低热（4/5）、精神及行为障碍（4/5）、惊厥（2/5）、重度意识障碍（2/5）和肢体无力（1/5）。与乙脑急性期头颅MRI结果相比，AE阶段头颅MRI显示3例患儿病变扩大，2例患儿病变无变化。AE阶段，4例患儿抗N-甲基-D-天冬氨酸受体抗体阳性（1例同时抗γ-氨基丁酸B型受体抗体阳性），1例所有AE抗体均为阴性。AE阶段的5例患儿免疫治疗均有效，随访3个月，其中1例基本恢复，4例仍有神经功能障碍。
乙脑可诱发AE，以抗N-甲基-D-天冬氨酸受体脑炎最为常见。AE阶段的症状与经典抗N-甲基-D-天冬氨酸受体脑炎相似。免疫治疗对乙脑继发AE患儿有效，预后可能与乙脑急性期神经功能障碍有关。
