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Induction and Clinical Scoring of Chronic-Relapsing Experimental Autoimmune Encephalomyelitis
Published on: July 4, 2007
Early psychiatric manifestations in pediatric autoimmune encephalitis: clinical data from a tertiary center
V Baglioni1, L Terenzi1, C Corazzina1
1Department of Human Neuroscience, Unit of Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via Dei Sabelli 108, 00185, Rome, Italy.
Insights
Pediatric autoimmune encephalitis (AE) can present with early psychiatric symptoms. Recognizing these signs is crucial for timely diagnosis and treatment of this rare neurological disorder.
Area of Science:
- Neuroimmunology
- Pediatric Neurology
- Child and Adolescent Psychiatry
Background:
- Autoimmune encephalitis (AE) is a rare, immune-mediated central nervous system disorder.
- Pediatric AE often presents with initial psychiatric symptoms, mimicking primary psychiatric conditions.
- This complicates early diagnosis in children and adolescents.
Purpose of the Study:
- To characterize the early psychiatric presentations of pediatric autoimmune encephalitis.
- To analyze clinical records of pediatric inpatients with new-onset psychiatric symptoms.
Main Methods:
- Retrospective observational study of inpatient admissions (July 2022-July 2024).
- Screened 1,577 admissions for acute psychiatric symptoms.
- Included 6 pediatric patients diagnosed with definite or probable AE.
Main Results:
- All 6 patients exhibited psychiatric symptoms like externalizing behaviors, mood disturbances with psychosis, and sleep disorders.
- Cerebrospinal fluid (CSF) abnormalities were found in 5/6 patients.
- Neuronal antibodies were identified in 4/6 patients (anti-NMDAR, anti-GAD65).
Conclusions:
- Early psychiatric symptoms are significant indicators of pediatric AE.
- Autoimmune causes should be considered in new-onset pediatric psychiatric presentations.
- Prompt diagnosis is vital, especially without a prior psychiatric history.
Background:
Autoimmune encephalitis (AE) comprises a rare and heterogeneous group of immune-mediated disorders affecting the central nervous system, frequently characterized by both psychiatric and neurological symptoms. In pediatric populations, acute psychiatric manifestations, such as agitation, mood instability, and psychosis, may precede neurological signs, often complicating early diagnosis due to their overlap with primary psychiatric disorders. This retrospective observational study aimed to characterize the early psychiatric presentations of pediatric AE through the analysis of clinical records concerning inpatient admissions to a tertiary Child and Adolescent Neuropsychiatry Unit.
Materials And Methods:
We screened 1,577 inpatient admissions for cases presenting with acute-onset psychiatric symptoms (July 2022-July 2024). Of 58 patients, 6 (mean age: 10.3 ± 5.2 years; 4 males, 2 females) received a final diagnosis of definite or probable AE based on established pediatric guidelines, thus meeting our inclusion criteria.
Results:
All patients presented with psychiatric symptoms, including externalizing behaviors (2/6), mood disturbances with psychotic features (4/6), and sleep disorders (4/6). All underwent comprehensive diagnostic evaluations, including cerebrospinal fluid (CSF) analysis, electroencephalography, and brain MRI. CSF biochemical abnormalities were detected in 5 out of 6 patients, while neuronal antibodies were identified in 4 out of 6 cases (two with anti-NMDAR and two with anti-GAD65 positivity, including one with both).
Conclusions:
Our findings underscore the relevance of early psychiatric symptoms in pediatric AE and emphasize the importance of considering autoimmune etiologies in new-onset psychiatric presentations, particularly in the absence of prior psychiatric history.
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