Son Seongsik, Lim Kil-Byung, Yoo Jeehyun, Song Pamela, Kim Jiyong
Department of Rehabilitation Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea.
Brain Neurorehabil. 2023 Jun 9;16(2):e12. doi: 10.12786/bn.2023.16.e12. eCollection 2023 Jul.
Anti-N-methyl-D-aspartate-receptor encephalitis is a complex autoimmune inflammatory neurological disorder that presents with epileptic seizures and rapid functional deterioration, including movement disorders and cognitive impairment, especially in young patients. Despite aggressive initial treatment with immune therapy, such as corticosteroids, intravenous immunoglobulin, and plasmapheresis, patients often need intensive rehabilitative therapies for their long-lasting deficits. We report a pediatric case of anti-N-methyl-D-aspartate receptor encephalitis in Korea that presented with symptoms of muscle weakness of the four extremities, dysarthria, dysphagia, and cognitive impairment in the acute phase. The patient underwent 4 weeks of comprehensive rehabilitative treatment, including physical therapy, occupational therapy, swallowing rehabilitation therapy, cognitive rehabilitation therapy, and speech therapy. At the follow-up evaluation after 4 weeks of treatment, she showed significant improvements in limb muscle strength, balance ability, swallowing, language function, and the ability to perform activities of daily living. However, when assessed using the Korean Wechsler Intelligence Scale for Children-IV, there was little improvement in cognitive function, particularly in working memory. While only a few cases have reported the progression of cognitive function using a standardized cognitive evaluation tool in patients with anti-N-methyl-D-aspartate receptor encephalitis, this present case report adds to the accumulation of evidence of neurocognitive deficits in these patients.
抗N-甲基-D-天冬氨酸受体脑炎是一种复杂的自身免疫性炎性神经疾病，表现为癫痫发作和功能迅速恶化，包括运动障碍和认知障碍，在年轻患者中尤为常见。尽管最初积极采用免疫疗法进行治疗，如使用皮质类固醇、静脉注射免疫球蛋白和血浆置换，但患者因长期存在的功能缺陷往往需要强化康复治疗。我们报告了韩国一例小儿抗N-甲基-D-天冬氨酸受体脑炎病例，该病例在急性期出现四肢肌肉无力、构音障碍、吞咽困难和认知障碍等症状。该患者接受了为期4周的综合康复治疗，包括物理治疗、职业治疗、吞咽康复治疗、认知康复治疗和言语治疗。在治疗4周后的随访评估中，她在肢体肌肉力量、平衡能力、吞咽、语言功能以及日常生活活动能力方面均有显著改善。然而，使用韩国韦氏儿童智力量表第四版进行评估时，认知功能改善甚微，尤其是工作记忆方面。虽然仅有少数病例报告了使用标准化认知评估工具对抗N-甲基-D-天冬氨酸受体脑炎患者认知功能进展情况，但本病例报告增加了这些患者神经认知缺陷的证据积累。
