Symptomatic treatment of children with anti-NMDAR encephalitis.
OBJECTIVE
We performed the first study on the perceived benefit and adverse effects of symptomatic management in children with anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis.


METHODS
A retrospective chart review was undertaken at two tertiary paediatric hospitals in Australia and New Zealand. We included 27 children (12 males, 15 females; mean age at admission 7y 1mo) with anti-NMDAR antibodies in serum or cerebrospinal fluid with a typical clinical syndrome.


RESULTS
Only two out of 27 patients were white, whereas 16 out of 27 patients were from the Pacific Islands/New Zealand Maori. The mean duration of admission was 69 days (10-224d) and 48% of patients (13/27) needed treatment in an intensive care setting. A mean of eight medications per patient was used for symptomatic management. Symptoms treated were agitation (n=25), seizures (n=24), movement disorders (n=23), sleep disruption (n=17), psychiatric symptoms (n=10), and dysautonomia (n=four). The medications used included five different benzodiazepines (n=25), seven anticonvulsants (n=25), eight sedatives and sleep medications (n=23), five antipsychotics (n=12), and five medications for movement disorders (n=10). Sedative and sleep medications other than benzodiazepines were the most effective, with a mean benefit of 67.4% per medication and a mean adverse effect-benefit ratio of 0.04 per medication. Antipsychotic drugs were used for a short duration (median 9d), and had the poorest mean benefit per medication of 35.4% and an adverse effect-benefit ratio of 2.0 per medication.


CONCLUSIONS
Long-acting benzodiazepines, anticonvulsants, and clonidine can treat multiple symptoms. Patients with anti-NMDAR encephalitis appear vulnerable to antipsychotic-related adverse effects. Pacific Islanders appear to have a vulnerability to anti-NMDAR encephalitis in our region.
Neuroimmunology Group, Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, Australia.|The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia.
Shekeeb S
SS
Mohammad
Department of Neuroservices, Starship Children's Hospital, Auckland, New Zealand.
Hannah
H
Jones
The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia.
Martin
M
Hong
Neuroimmunology Group, Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, Australia.|Paediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy.
Margherita
M
Nosadini
Department of Neuroservices, Starship Children's Hospital, Auckland, New Zealand.
Cynthia
C
Sharpe
Neuroimmunology Group, Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, Australia.
Sekhar C
SC
Pillai
Neuroimmunology Group, Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, Australia.
Fabienne
F
Brilot
Neuroimmunology Group, Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, Australia.|The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia.
Russell C
RC
Dale
D000293:Adolescent; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications* / Q000188:drug therapy*; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D001315:Australia; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000209:etiology; D009069:Movement Disorders / Q000188:drug therapy / Q000209:etiology; D009520:New Zealand; D054969:Primary Dysautonomias / Q000188:drug therapy / Q000209:etiology; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000209:etiology; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D012893:Sleep Wake Disorders / Q000188:drug therapy / Q000209:etiology
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines