Abstract
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis has a very good outcome; however,
there are few reports in developing countries regarding the outcome of pediatric anti-NMDAR
encephalitis. We aimed to report the clinical outcome of pediatric anti-NMDAR encephalitis
in the rural area of Thailand. This retrospective cohort study recruited children
between the age of 1 month and 15 years with the diagnosis of anti-NMDAR encephalitis
admitted at Maharat Nakhon Ratchasima Hospital from 1st May 2015 to 31th March 2020.
Baseline characteristics and investigation were recorded. The first-line treatment
was intravenous pulse methylprednisolone alone, pulse methylprednisolone plus intravenous
immune globulin (IVIG), or IVIG alone. The second-line treatment was monthly intravenous
cyclophosphamide or azathioprine. The modified Rankin Scale (MRS) was used for evaluation
at 1, 3, 6, 12, 18, and 24 months after receiving first-line treatment to determine
clinical outcomes. The factors that may affect the outcomes were evaluated. In total,
17 patients were recruited, with the mean age of 8 years, and 76.46% were female.
82.35% of patients developed seizures, and 52.94% turned to status epilepticus. 70.59%
received first-line treatment as pulse methylprednisolone plus IVIG. 82.35% received
complete follow-up at 12 months. According to MRS score, at first diagnosis 94.12%
reported severe disability, at 1 month after receiving treatment, 47.06% improved
to moderate–mild disability, and at 6 and 12 months, 40% and 78.57% had complete recovery,
respectively. Different types of first-line and second-line treatments did not affect
the clinical outcome. Comorbidity of status epilepticus affected MRS. Anti-NMDAR encephalitis
has a very good prognosis; prompt diagnosis is necessary. Comorbidity as status epilepticus
may affect the clinical outcome.
Keywords
Anti-NMDAR encephalitis - Pediatric - Outcome - Factors
