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Published on: July 4, 2007
Rate of Autoimmune Encephalitis in Children With First-Episode Psychosis
Geffen Treiman1, Laura Blackwell2, Robyn Howarth2
1Emory University School of Medicine, Atlanta, Georgia.
Insights
The first-episode psychosis (FEP) diagnostic algorithm effectively identifies autoimmune encephalitis (AE) in children. This algorithm aids in determining which pediatric FEP patients require cerebrospinal fluid (CSF) testing for accurate diagnosis.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Psychiatry
Background:
- Autoimmune encephalitis (AE) can manifest as first-episode psychosis (FEP) in children.
- The diagnostic utility of a proposed FEP algorithm in pediatric populations remains unestablished.
- This study evaluates the application of the FEP diagnostic algorithm in children presenting with FEP.
Purpose of the Study:
- To assess the effectiveness of the first-episode psychosis (FEP) diagnostic algorithm in a pediatric cohort.
- To determine the algorithm's ability to identify children with autoimmune encephalitis (AE) among FEP cases.
- To evaluate the algorithm's recommendation for cerebrospinal fluid (CSF) testing in pediatric FEP.
Main Methods:
- Retrospective cohort study of children diagnosed with first-episode psychosis (FEP).
- Application of the established FEP diagnostic algorithm to the pediatric cohort.
- Analysis of algorithm's recommendations for cerebrospinal fluid (CSF) testing and correlation with diagnoses.
Main Results:
- The FEP algorithm demonstrated 100% sensitivity in identifying autoimmune encephalitis (AE) cases.
- The algorithm recommended CSF testing for all pediatric AE patients (100%) and 32% of non-AE patients.
- Specificity was 45.5% with a negative predictive value of 100% for the FEP algorithm in this cohort.
Conclusions:
- First-episode psychosis (FEP) in children can stem from diverse causes, including autoimmune encephalitis (AE) and metabolic disorders.
- A broad diagnostic evaluation is crucial for pediatric FEP, particularly when CSF shows no inflammation.
- The FEP algorithm is a valuable tool for guiding cerebrospinal fluid (CSF) testing decisions in pediatric FEP cases.
Background:
Autoimmune encephalitis (AE) can present as first-episode psychosis (FEP) in children. An FEP diagnostic algorithm has been proposed, but how this algorithm applies to children is unknown. We assess the FEP diagnostic algorithm in children with FEP.
Methods:
The FEP algorithm was applied to a retrospective cohort of children with FEP without other neurological symptoms.
Results:
Twenty-four patients were included, with five AE (anti-N-methyl-d-aspartate receptor encephalitis) and 19 non-AE patients (12 primary psychiatric, two headaches, mycoplasma-related encephalitis, post-coronavirus disease 2019 encephalitis, drug reaction with eosinophilia and systemic symptoms [DRESS] syndrome, cobalamin C deficiency, and two unknown). Some non-AE patients (five of 19 = 26%) received immunotherapies, with symptom resolution in one of five (20%) with immunotherapy and in four of 14 (29%) without immunotherapy. The FEP algorithm recommended cerebrospinal fluid (CSF) testing in all (five of five = 100%) patients with AE and in six of 19 (32%) non-AE patients, resulting in 100% sensitivity (95% confidence interval [CI]: 100% to 100%) and 45.5% specificity (95% CI: 16% to 75%), with a negative predictive value of 100% (95% CI: 100% to 100%).
Conclusions:
FEP can occur in children from different causes, including AE and metabolic conditions. Evaluation of FEP should be broad, especially without CSF evidence of inflammation. The FEP algorithm is useful to assess patients who would benefit from CSF testing and should be assessed in larger cohorts.
