Approach to the Management of Pediatric-Onset Anti-N-Methyl-d-Aspartate (Anti-NMDA) Receptor Encephalitis: A Case Series.
Anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis is a treatable cause of autoimmune encephalitis. It remains unclear if the natural history of this disease is altered by choice of acute therapy or the employment of chronic immunotherapy. Chart review was undertaken for pediatric patients diagnosed with anti-NMDA receptor encephalitis. Data obtained included patient demographics, disease manifestations, treatment course, and clinical outcomes. Ten patients with anti-NMDA receptor encephalitis were identified. All patients were treated with immunotherapy in the acute period, and all patients experienced good recovery. Neurologic relapse did not occur in any patient. All patients received varied forms of chronic immunosuppression to prevent relapses. Complications of chronic immunotherapy occurred in 50% of patients. The benefits of chronic immunotherapy and the duration of use should be carefully weighed against the risks. Complications from immunotherapy are not uncommon and can be serious. Clinical trials assessing the benefit of long-term immunotherapy in this population are needed.
Department of Neurology, Division of Pediatric Neurology, University of Virginia, Charlottesville, VA, USA jnb8h@virginia.edu.
J Nicholas
JN
Brenton
Advanced Pediatrics, Vienna, VA, USA.
Joshua
J
Kim
Department of Pediatrics, Inova Children's Hospital, Falls Church, VA, USA.
Richard H
RH
Schwartz
D000293:Adolescent; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D019468:Disease Management; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007167:Immunotherapy; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
D007155:Immunologic Factors
NMDA; autoimmune; encephalitis; pediatric