Early Functional Outcomes for Pediatric Patients Diagnosed with Anti-N-Methyl-D-Aspartate Receptor Encephalitis
Robyn A Howarth1, Joshua Vova, Laura S Blackwell
1From the Departments of Neuropsychology (RAH, LSB) and Physical Medicine & Rehabilitation (JV), Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
Insights
Pediatric patients with anti-N-methyl-D-aspartate receptor encephalitis showed significant functional gains during inpatient rehabilitation. However, persistent deficits highlight the need for continued monitoring and intervention for these young patients.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune neurological disorder affecting children.
- Characterizing the rehabilitation needs and outcomes of pediatric patients with NMDAR encephalitis is crucial for optimizing care.
Purpose of the Study:
- To describe the demographic and clinical features of pediatric patients with NMDAR encephalitis undergoing inpatient rehabilitation.
- To evaluate early functional outcomes and identify predictors of recovery in this population.
Main Methods:
- Retrospective chart review of 27 pediatric patients with NMDAR encephalitis who received intensive inpatient neurorehabilitation.
- Analysis of Functional Independence Measure for Children (WeeFIM) Developmental Functional Quotient (DFQ) scores from admission to discharge.
Main Results:
- Patients, averaging 10.6 years old at onset, showed significant improvements in WeeFIM DFQ scores (admission: 28.6, discharge: 54.3).
- Younger age at onset, seizures, and number of treatments were associated with poorer discharge outcomes.
- Time to treatment initiation did not correlate with early functional outcomes.
Conclusions:
- Pediatric NMDAR encephalitis patients achieve substantial functional gains during inpatient rehabilitation.
- Persistent deficits necessitate ongoing monitoring and tailored interventions post-discharge.
Objective:
The aims of the current study were to characterize the demographic and clinical presentation of pediatric patients diagnosed with anti-N-methyl-D-aspartate receptor encephalitis who require inpatient rehabilitation, to examine early functional outcomes, and to investigate predictors of early recovery.
Design:
A retrospective chart review was conducted for 27 pediatric patients diagnosed with anti-N-methyl-D-aspartate receptor encephalitis who received intensive inpatient neurorehabilitation.
Results:
On average, patients were 10.6 yrs of age (range, 2-18 yrs) at the time of symptom onset. Average time to treatment from symptom onset was 27.2 days (range, 5-91 days). Patients displayed significant improvements between admission and discharge Functional Independence Measure for Children (WeeFIM) Developmental Functional Quotient (DFQ) scores across patients (P < 0.01). Mean Functional Independence Measure for Children Total Developmental Functional Quotient score at admission was 28.6 (range, 15.0-62.6) and at discharge was 54.3 (range, 14.2-91.9). Younger age at onset, seizures, and number of treatments received were associated with worse functional outcomes at discharge. Time to initiate treatment was not found to be associated with early functional outcomes.
Conclusion:
Pediatric patients diagnosed with anti-N-methyl-D-aspartate receptor encephalitis displayed significant functional gains during inpatient rehabilitation, despite persistent functional deficits at discharge, suggesting the need for ongoing monitoring and intervention.
To Claim Cme Credits:
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) Recognize the clinical presentation of anti-N-methyl-D-aspartate receptor encephalitis in pediatric patients, (2) Appreciate the role of rehabilitation in the care of the pediatric patient with anti-N-methyl-D-aspartate receptor encephalitis, and (3) Identify demographic and clinical variables that predict poor functional outcomes after rehabilitation in pediatric patients with anti-N-methyl-D-aspartate receptor encephalitis.
Level:
Advanced.
Accreditation:
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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