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Extended Clinical Spectrum of Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Children: A Case Series.
Pediatr Neurol. 2017 Jul; 72:51-55.PN

Abstract

OBJECTIVE

There is a wide spectrum of clinical manifestations in children with anti-N-methyl-d-aspartate (NMDA) receptor antibody encephalitis from two different health care settings.

METHODS

We describe our experience with 13 patients (median age, 7 years; range, 5 months to 19 years) presenting to tertiary referral centers in India and the United States.

RESULTS

Initial manifestations were neurological (seizures or movement disorders) in eight patients, and psychiatric (e.g., emotional lability and hallucination) in five patients. Symptoms during the clinical course included seizures in ten patients, movement disorders (dyskinesia and choreiform movements) in 11 patients, and behavioral changes (aggressiveness and insomnia) in ten patients. Concomitant infections (herpes simplex virus 1, tuberculous meningitis, and influenza A) were present in three patients. Analysis of the cerebrospinal fluid in all except two cases preceded by infection (herpes simplex virus encephalitis and tuberculous meningitis) was unremarkable. Treatment included intravenous immunoglobulin/methylprednisolone (11 patients), rituximab (eight patients), plasmapheresis (two patients), and cyclophosphamide (two patients). Six patients recovered completely. Two patients had mild residual neurological deficits, whereas four had severe residual neurological deficits. Two patients had profound autonomic instability, which was the cause of death for one of them. Two patients relapsed at two and six months after the initial recovery.

CONCLUSIONS

We describe the differences and similarities of clinical presentation, test results, and response to treatment of children with anti-N-methyl-d-aspartate receptor encephalitis from India and the United States. Included is a description of one of the youngest patients with anti-N-methyl-d-aspartate receptor encephalitis (five months) and the first patient to be reported in association with tuberculous meningitis.

Authors+Show Affiliations

Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. Electronic address: ajaygoenka2011@hotmail.com.Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India.Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28506503

Citation

Goenka, Ajay, et al. "Extended Clinical Spectrum of Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Children: a Case Series." Pediatric Neurology, vol. 72, 2017, pp. 51-55.
Goenka A, Jain V, Nariai H, et al. Extended Clinical Spectrum of Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Children: A Case Series. Pediatr Neurol. 2017;72:51-55.
Goenka, A., Jain, V., Nariai, H., Spiro, A., & Steinschneider, M. (2017). Extended Clinical Spectrum of Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Children: A Case Series. Pediatric Neurology, 72, 51-55. https://doi.org/10.1016/j.pediatrneurol.2017.03.010
Goenka A, et al. Extended Clinical Spectrum of Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Children: a Case Series. Pediatr Neurol. 2017;72:51-55. PubMed PMID: 28506503.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extended Clinical Spectrum of Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Children: A Case Series. AU - Goenka,Ajay, AU - Jain,Vivek, AU - Nariai,Hiroki, AU - Spiro,Alfred, AU - Steinschneider,Mitchell, Y1 - 2017/04/05/ PY - 2016/11/14/received PY - 2017/03/13/revised PY - 2017/03/18/accepted PY - 2017/5/17/pubmed PY - 2018/3/30/medline PY - 2017/5/17/entrez KW - acute psychosis KW - autonomic instability KW - movement disorder KW - seizures SP - 51 EP - 55 JF - Pediatric neurology JO - Pediatr. Neurol. VL - 72 N2 - OBJECTIVE: There is a wide spectrum of clinical manifestations in children with anti-N-methyl-d-aspartate (NMDA) receptor antibody encephalitis from two different health care settings. METHODS: We describe our experience with 13 patients (median age, 7 years; range, 5 months to 19 years) presenting to tertiary referral centers in India and the United States. RESULTS: Initial manifestations were neurological (seizures or movement disorders) in eight patients, and psychiatric (e.g., emotional lability and hallucination) in five patients. Symptoms during the clinical course included seizures in ten patients, movement disorders (dyskinesia and choreiform movements) in 11 patients, and behavioral changes (aggressiveness and insomnia) in ten patients. Concomitant infections (herpes simplex virus 1, tuberculous meningitis, and influenza A) were present in three patients. Analysis of the cerebrospinal fluid in all except two cases preceded by infection (herpes simplex virus encephalitis and tuberculous meningitis) was unremarkable. Treatment included intravenous immunoglobulin/methylprednisolone (11 patients), rituximab (eight patients), plasmapheresis (two patients), and cyclophosphamide (two patients). Six patients recovered completely. Two patients had mild residual neurological deficits, whereas four had severe residual neurological deficits. Two patients had profound autonomic instability, which was the cause of death for one of them. Two patients relapsed at two and six months after the initial recovery. CONCLUSIONS: We describe the differences and similarities of clinical presentation, test results, and response to treatment of children with anti-N-methyl-d-aspartate receptor encephalitis from India and the United States. Included is a description of one of the youngest patients with anti-N-methyl-d-aspartate receptor encephalitis (five months) and the first patient to be reported in association with tuberculous meningitis. SN - 1873-5150 UR - https://www.unboundmedicine.com/medline/citation/28506503/Extended_Clinical_Spectrum_of_Anti_N_Methyl_d_Aspartate_Receptor_Encephalitis_in_Children:_A_Case_Series_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0887-8994(16)30931-6 DB - PRIME DP - Unbound Medicine ER -