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Dong J, Yi X. The Diagnostic Challenge and Prognosis of Autoimmune Encephalitis in Children: A Single-Center Retrospective Study. Pediatr Neurol 2023; 146:103-109. [PMID: 37467622 DOI: 10.1016/j.pediatrneurol.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Autoimmune encephalitis (AE) is an immune-mediated encephalitis; nevertheless, its diagnosis in children remains challenging. This study aimed to reveal the clinical characteristics, diagnostic processes, and therapeutic outcomes of AE in children. METHODS A total of 18 children with AE were enrolled. Antibody assay was performed in the cerebrospinal fluid (CSF) and serum samples by indirect immunofluorescence. Electroencephalography (EEG) and magnetic resonance imaging (MRI) were monitored to reflect abnormal neural signals. In addition, demographics data, neurological symptoms, therapeutic strategies, and outcomes were recorded and analyzed. RESULTS Convulsion (50.00%) and emotional disturbance (44.44%) were common clinical symptoms of AE. The biochemical parameters in the CSF had a relatively low diagnostic value. Antibodies in the CSF were dominant in the diagnosis of AE but those in the serum were limited in the diagnosis of anti-MOG or anti-LGI1 AE. In addition, all children showed abnormalities in EEG (72.22%) or MRI (66.67%). Methylprednisolone combined with sequential oral prednisone (83.33%) and gamma globulin (88.89%) were the dominant drugs, achieving an overall recovery rate of 72.22%. However, there were still two patients who had poor outcomes, including Patient 3 with a young age (two years old) and progressive symptom and Patient 12 with a long disease course before treatment (>120 days). CONCLUSIONS The clinical manifestations of AE are varied in children. Antibody in the CSF was dominant, and EEG and MRI were instructive in the diagnosis of AE. Young age, progressive symptom, and prolonged disease course before treatment may contribute to poor outcomes.
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Affiliation(s)
- Jingjing Dong
- Department of Pediatric Neurology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
| | - Xiaoli Yi
- Department of Radiology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
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Rzhevska OO, Khodak LA, Butenko AI, Kvaratskheliya TM, Shtrakh KV, Shevchuk AM, Yashchenko YB. EBV-ENCEPHALITIS IN CHILDREN: DIAGNOSTIC CRITERIA. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2263-2268. [PMID: 37948724 DOI: 10.36740/wlek202310120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim: To investigate the clinical characteristics of EBV infection in the pediatric nervous system using laboratory methods and brain MRI data. PATIENTS AND METHODS Materials and methods: We observed 41 children with EBV encephalitis ranging from 8 months to 17 years old. The diagnosis of EBV-encephalitis was established on the basis of clinical and medical history, laboratory and instrumental (brain MRI) data. The main thing in the diagnosis was clinical symptoms, combining general infection, cerebral syndromes and focal neurological symptoms. The etiology of Epstein-Barr virus was determined using ELISA and PCR. RESULTS Results: EBV-encephalitis can be as a manifestation of reactivation of persistent EBV infection (85%), much less often - acute primary EBV infection (15%). By nature, the duration of EBV encephalitis has distinguished two forms of its course: acute (63%) and chronioc (37%). The criteria of differential diagnosis of acute and chronic forms of EBV-encephalitis are proposed, which include the most common anamnesis data, clinical manifestations and changes in brain MRI. CONCLUSION Conclusions: The proposed criteria specifically for acute and chronic forms of EBV-encephalitis can contribute to the timely and more accurate diagnosis of this disease in children.
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Affiliation(s)
- Olga O Rzhevska
- V.N. KARAZIN KHARKIV NATIONAL UNIVERSITY, KHARKIV, UKRAINE; PRIVATE INSTITUTION OF HIGHER EDUCATION «KYIV MEDICAL UNIVERSITY», KYIV, UKRAINE
| | | | - Antonina I Butenko
- V.N. KARAZIN KHARKIV NATIONAL UNIVERSITY, KHARKIV, UKRAINE; STATE INSTITUTION «INSTITUTE FOR CHILDREN AND ADOLESCENT`S HEALTH CARE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE
| | - Tamara M Kvaratskheliya
- V.N. KARAZIN KHARKIV NATIONAL UNIVERSITY, KHARKIV, UKRAINE; STATE INSTITUTION «INSTITUTE FOR CHILDREN AND ADOLESCENT`S HEALTH CARE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE
| | | | | | - Yurii B Yashchenko
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
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LGI-1 encephalopathy following ChAdOx1 nCov-19 vaccination. Neurol Res Pract 2022; 4:24. [PMID: 35718786 PMCID: PMC9206881 DOI: 10.1186/s42466-022-00187-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/04/2022] [Indexed: 01/22/2023] Open
Abstract
AbstractA 71-year-old male patient was diagnosed with LGI1 encephalopathy 4 weeks following a first ChAdOx1 nCov-19 vaccination. Extensive work-up including analysis of CSF and PET examination did not reveal a tangible cause so that a vaccine-associated encephalopathy was considered as differential diagnosis. Under steroid treatment, the faciobrachial dystonic seizures subsided.
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Lee KY. Common immunopathogenesis of central nervous system diseases: the protein-homeostasis-system hypothesis. Cell Biosci 2022; 12:184. [PMCID: PMC9668226 DOI: 10.1186/s13578-022-00920-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022] Open
Abstract
AbstractThere are hundreds of central nervous system (CNS) diseases, but there are few diseases for which the etiology or pathogenesis is understood as well as those of other organ-specific diseases. Cells in the CNS are selectively protected from external and internal insults by the blood–brain barrier. Thus, the neuroimmune system, including microglia and immune proteins, might control external or internal insults that the adaptive immune system cannot control or mitigate. The pathologic findings differ by disease and show a state of inflammation that reflects the relationship between etiological or inflammation-inducing substances and corresponding immune reactions. Current immunological concepts about infectious diseases and infection-associated immune-mediated diseases, including those in the CNS, can only partly explain the pathophysiology of disease because they are based on the idea that host cell injury is caused by pathogens. Because every disease involves etiological or triggering substances for disease-onset, the protein-homeostasis-system (PHS) hypothesis proposes that the immune systems in the host control those substances according to the size and biochemical properties of the substances. In this article, I propose a common immunopathogenesis of CNS diseases, including prion diseases, Alzheimer’s disease, and genetic diseases, through the PHS hypothesis.
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Pangprasertkul S, Sanguansermsri C, Sudjaritruk T. Epstein-Barr virus meningoencephalitis in a young immunocompetent child: A case report. Heliyon 2022; 8:e11150. [PMID: 36299527 PMCID: PMC9589165 DOI: 10.1016/j.heliyon.2022.e11150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/07/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Epstein-Barr virus (EBV) usually causes mild, asymptomatic, and self-recovered infections in young children. Yet, neurological involvement of this virus has been reported. EBV meningoencephalitis is relatively rare in immunocompetent children. Herein, we describe a case of 2-year-old previously healthy girl presented with high-grade fever and exudative tonsillitis. Her neurological examination showed alteration of consciousness and neck stiffness. A history of generalized tonic-clonic seizures was noted. A diagnosis of EBV meningoencephalitis was definitely confirmed by a positive result for serum viral capsid antigen IgM, and a detection of EBV DNA in cerebrospinal fluid. Her neuroimaging studies demonstrated evidence of leptomeningeal enhancements along bilateral parietal cortical sulci and around the brainstem with a hypodense lesion in the left parietal area – the typical findings of EBV meningoencephalitis. This patient was treated with intravenous corticosteroid without antiviral agents. Her clinical symptoms gradually improved. She was discharged from the hospital on the 19th day of hospitalization without neurological sequelae. Although EBV is not a primary causative agent of meningoencephalitis in immunocompetent children, it should always be considered regardless of the presence or absence of classical infectious mononucleosis symptoms. Early recognition and properly treatment are important for a good prognosis. EBV meningoencephalitis is relatively rare in immunocompetent children. EBV should be considered as a causative agent for children with acute meningoencephalitis, regardless of classical IM symptoms. Diagnosis of EBV-related CNS infections relies on serology, molecular testing and neuroimaging studies. Treatment of EBV meningoencephalitis with antiviral agents or corticosteroid is controversial.
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Affiliation(s)
- Sipang Pangprasertkul
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chinnuwat Sanguansermsri
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tavitiya Sudjaritruk
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical and Molecular Epidemiology of Emerging and Re-emerging Infectious Diseases Research Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Corresponding author.
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Hacke W. A look back at 3 years of neurological research and practice (NRP). Neurol Res Pract 2022; 4:19. [PMID: 35484603 PMCID: PMC9047386 DOI: 10.1186/s42466-022-00182-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Werner Hacke
- University Hospital Heidelberg, Rubrechts-Karl-University Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Lee S, Kim HD, Lee JS, Kang HC, Kim SH. Clinical Features and Treatment Outcomes of Seronegative Pediatric Autoimmune Encephalitis. J Clin Neurol 2021; 17:300-306. [PMID: 33835752 PMCID: PMC8053533 DOI: 10.3988/jcn.2021.17.2.300] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose New diagnostic criteria for pediatric autoimmune encephalitis (AIE) have been introduced recently. A substantial proportion of cases of pediatric AIE are diagnosed as seronegative based on these criteria, and so the clinical characteristics of this group remain to be investigated. Methods This study included 46 pediatric patients younger than 18 years with suspected AIE. Clinical features, laboratory or radiological findings, and treatment outcomes were compared between seronegative and seropositive patients. Results Nine (19.6%) of the 46 patients were diagnosed as seropositive AIE. All of the patients with seropositive AIE had anti-N-methyl-D-aspartate receptor antibodies. Commonly identified neuropsychiatric symptoms were altered mental status, cognitive dysfunction, seizure, speech dysfunction, and psychotic disorder in both the seronegative and seropositive groups. Immunotherapy produced favorable treatment outcomes in both the seropositive (n=7, 77.8%) and seronegative (n=35, 94.6%) AIE patients. Treatment outcomes for first-line immunotherapy were better in seronegative AIE than seropositive AIE patients (p=0.003), and hence a smaller proportion of seronegative patients required second-line treatment (p=0.015). Conclusions Pediatric seronegative AIE patients showed clinical presentations similar to those of seropositive AIE patients, with favorable treatment outcomes after immunotherapy.
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Affiliation(s)
- Sangbo Lee
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon Chul Kang
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| | - Se Hee Kim
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
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Kamate M, Ritesh BR, Garg D, Sharma S. Do All Children With Autoimmune Encephalitis Need Aggressive Immunotherapy? Indian Pediatr 2020; 57:1087-1088. [PMID: 33231193 PMCID: PMC7678600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2024]
Affiliation(s)
- Mahesh Kamate
- Division of Pediatric Neurology, Department of Pediatrics, KAHER’s Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - B. R. Ritesh
- Division of Pediatric Neurology, Department of Pediatrics, KAHER’s Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Divyani Garg
- Departments of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Suvasini Sharma
- Pediatrics (Neurology Division), Lady Hardinge Medical College, New Delhi, India
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