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Clinical Features of Children With Anti-N-Methyl-D-Aspartate Receptor Encephalitis Following Viral Encephalitis
Vu Thi Minh Phuong1,2, Phung Thi Bich Thuy1,3, Dao Huu Nam2
1Department of Pediatrics, Hanoi Medical University, Hanoi, Vietnam.
Insights
Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) can follow viral encephalitis. Children with anti-NMDARE after herpes simplex encephalitis or Japanese encephalitis often develop movement disorders and psychiatric symptoms.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) is a recognized complication following viral encephalitis, including herpes simplex encephalitis (HSE) and Japanese encephalitis (JE).
- Understanding the distinct clinical presentations and outcomes of anti-NMDARE post-viral encephalitis in children is crucial for timely diagnosis and management.
Purpose of the Study:
- To delineate the clinical characteristics, laboratory findings, and treatment outcomes of pediatric patients experiencing anti-NMDARE subsequent to viral encephalitis.
- To compare the clinical and laboratory features between the initial viral encephalitis phase and the subsequent anti-NMDARE phase.
Main Methods:
- A retrospective case series involving 14 children diagnosed with anti-NMDARE following viral encephalitis (HSE or JE) between January 2021 and December 2022.
- Exclusion criteria included evidence of viral reactivation or other specific antibodies to ensure focus on anti-NMDARE post-viral encephalitis.
Main Results:
- The majority of patients (12/14) developed anti-NMDARE after HSE. Common initial symptoms included fever and seizures, with no movement disorders or psychiatric symptoms. Post-anti-NMDARE, movement disorders (92.9%), fever (71.4%), sleep disturbances (64.3%), seizures (50%), and psychiatric symptoms (50%) were prevalent.
- Cerebrospinal fluid (CSF) analysis showed variations between phases, with a higher protein concentration during the anti-NMDARE phase (0.85 ± 0.63 g/L) compared to the viral encephalitis phase (0.43 ± 0.16 g/L).
- Brain MRI scans in 10 patients revealed no new lesions in 8 cases, suggesting limited structural changes despite distinct clinical manifestations.
Conclusions:
- Significant differences exist in clinical symptoms and CSF findings between viral encephalitis and subsequent anti-NMDARE phases in children.
- Despite the distinct clinical evolution, most pediatric patients in this cohort did not exhibit new brain lesions on MRI, highlighting the importance of clinical and CSF findings for diagnosis.
Background:
Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) can occur after herpes simplex encephalitis (HSE) and Japanese encephalitis (JE). We describe the clinical features of children with anti-NMDARE after viral encephalitis.
Objective:
This study aims to describe the clinical characteristics, laboratory findings, and treatment outcomes of these patients.
Methods:
We describe the clinical characteristics of 14 children of anti-NMDARE following viral encephalitis treated at National Children's Hospital from January 2021 to December 2022. Patients with evidence of viral reactivation or other antibodies were excluded.
Results:
There are 12 children with anti-NMDARE after HSE and 2 children after JE. The median age was 2.1 years (range 0.6-12.9), with 8 male patients. All patients (100%) had fever and seizures, while 50% exhibited focal neurological signs. No patients experienced movement disorders, psychiatric symptoms, or sleep disturbances during the viral encephalitis phase. In contrast, the most common symptoms during the anti-NMDARE phase were as follows: movement disorders in 92.9% (13/14), recurrent or prolonged fever in 71.4% (10/14), sleep disturbances in 64.3% (9/14), seizures in 50% (7/14), and psychiatric symptoms in 50% (7/14). The median cerebrospinal fluid (CSF) white blood cell count in the viral encephalitis and anti-NMDARE phases was 57 (4-410) and 13 (2-48), respectively. The mean CSF protein concentration was 0.43 ± 0.16 g/L and 0.85 ± 0.63 g/L, respectively. Brain MRI was performed in both encephalitis phases for 10/14 patients, with 8/10 showing no new lesions.
Conclusion:
There were differences in clinical symptoms and CSF findings between the two phases of encephalitis; however, most patients did not develop new lesions on brain MRI.
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