Clinical analysis of 73 children with anti-N-methyl-D-aspartic receptor (NMDAR) encephalitis
Lingdong Zeng1, Yunli Han2, Shiqin Huang2
1Department of Pediatrics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
Insights
Pediatric anti-N-methyl-D-aspartic receptor (NMDAR) encephalitis prognosis is linked to disease severity and MRI findings. Elevated peak modified Rankin Scale scores and abnormal neuroimaging predict poor outcomes in children with anti-NMDAR encephalitis.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Anti-N-methyl-D-aspartic receptor (NMDAR) encephalitis is a severe neurological disorder affecting children.
- Early identification of clinical features and prognostic factors is crucial for effective management.
Purpose of the Study:
- To assess clinical characteristics and treatment outcomes in pediatric anti-NMDAR encephalitis.
- To identify independent prognostic risk factors for poor outcomes in this population.
Main Methods:
- Retrospective analysis of 73 pediatric patients with anti-NMDAR encephalitis.
- Evaluation of demographic data, clinical presentation, MRI, EEG, treatments, and follow-up outcomes using modified Rankin Scale (mRS).
- Multivariate logistic regression to determine independent prognostic factors for poor prognosis (mRS >2).
Main Results:
- 69.86% of patients had favorable outcomes (mRS ≤2), while 30.14% had poor prognosis (mRS >2).
- Significant differences between groups included peak mRS scores, abnormal MRI findings, and EEG δ brush patterns.
- Elevated peak mRS scores (OR=3.12) and abnormal neuroimaging (OR=2.78) were independent risk factors for poor prognosis.
Conclusions:
- Peak disease severity (mRS) and structural brain abnormalities on MRI are significant prognostic indicators.
- These factors should be integrated into clinical risk stratification for pediatric anti-NMDAR encephalitis.
- Informed therapeutic decisions and prognostic counseling can be enhanced by utilizing these indicators.
Background:
Anti-N-methyl-D-aspartic receptor (NMDAR) encephalitis is a severe neurological condition often seen in pediatric patients. Early identification of clinical characteristics and prognostic risk factors is essential for optimizing diagnosis and treatment. This study aimed to systematically assess the clinical features and treatment outcomes of pediatric anti-NMDAR encephalitis and to identify independent prognostic risk factors for poor outcomes.
Methods:
This retrospective study included 73 pediatric patients with anti-NMDAR encephalitis. Demographic information, clinical presentation, diagnostic information [magnetic resonance imaging (MRI) and electroencephalography (EEG)], treatments received, and follow-up data were reviewed and analyzed. Based on modified Rankin Scale (mRS) scores at 2-month post-treatment follow-up, patients were stratified into favorable prognosis (mRS ≤2) and poor prognosis (mRS >2) groups. Comparative analyses of clinical parameters were performed using independent samples t-tests for continuous variables and the Pearson Chi-squared test for categorical variables. Statistically significant variables from univariate analyses were subsequently entered into a multivariate logistic regression model to identify independent prognostic factors.
Results:
Among the cohort, 51 patients (69.86%) achieved favorable outcomes, while 22 patients (30.14%) exhibited poor prognosis. Significant intergroup differences emerged in peak mRS scores (t=5.32, P<0.001), presence of abnormal MRI findings (χ2=8.15, P=0.004), and the presence of δ brush patterns on EEG (χ2=6.43, P=0.01). Multivariate logistic regression analysis identified two independent risk factors for a poor prognosis: elevated peak mRS scores [odds ratio (OR) =3.12, 95% confidence interval (CI): 1.45-6.72; P=0.004] and abnormal neuroimaging findings (OR =2.78, 95% CI: 1.18-6.54; P=0.02).
Conclusions:
Our findings demonstrate that elevated peak disease severity (as quantified by mRS) and structural brain abnormalities on MRI represent significant prognostic indicators in pediatric anti-NMDAR encephalitis. These parameters should be incorporated into clinical risk stratification models to guide therapeutic decision-making and prognostic counselling.
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