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Chen LW, Olivé-Cirera G, Fonseca EG, Mistieri Simabukuro M, Iizuka T, Armangue T, Dalmau J. Very Long-Term Functional Outcomes and Dependency in Children With Anti-NMDA Receptor Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200235. [PMID: 38621190 PMCID: PMC11087043 DOI: 10.1212/nxi.0000000000200235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/06/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To assess the daily function of children with anti-N-methyl-d-aspartate receptor encephalitis (NMDARe) after a minimal follow-up of 5 years. METHODS Patients 18 years and younger by the time of disease onset, whose serum and CSF were studied in our center between 2013 and 2017, were included in the study. Patients' daily life function was assessed by their physicians using a 15-domain question format (Liverpool Outcome Score). RESULTS Of 76 patients, 8 (11%) died and 68 were followed for a mean of 7.1 years (SD 1.5 years, range: 5.0-10.1). Three outcome patterns were identified: full recovery (50; 73%); behavioral and school/working deficits (12; 18%); and multidomain deficits (6; 9%) involving self-care ability, behavioral-cognitive impairment, and seizures. Younger age of disease onset was significantly associated with multidomain deficits (OR 1.6, 95% CI 1.02-2.4, p = 0.04), particularly in children younger than 6 years, among whom 8 of 23 (35%) remained sociofamiliar dependent. DISCUSSION After a minimal follow-up of 5 years, most children with NMDARe had substantial or full functional recovery, but approximately one-fifth remained with behavioral and school/working deficits. The younger the patient at disease onset, the more probable it was to remain with multidomain deficits and dependent on sociofamiliar support.
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Affiliation(s)
- Li-Wen Chen
- From the Group of Experimental Neuroimmunology (L.-W.C., G.O.-C., E.G.F., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Caixa Research Institute, Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Neurology Service (E.G.F., J.D.), Hospital Clínic Barcelona; Pediatric Neuroimmunology Unit (E.G.F., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, University of São Paulo, Brazil; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Centro de Investigación Biomédica en Red (J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and University of Barcelona (J.D.), Barcelona, Spain
| | - Gemma Olivé-Cirera
- From the Group of Experimental Neuroimmunology (L.-W.C., G.O.-C., E.G.F., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Caixa Research Institute, Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Neurology Service (E.G.F., J.D.), Hospital Clínic Barcelona; Pediatric Neuroimmunology Unit (E.G.F., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, University of São Paulo, Brazil; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Centro de Investigación Biomédica en Red (J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and University of Barcelona (J.D.), Barcelona, Spain
| | - Elianet G Fonseca
- From the Group of Experimental Neuroimmunology (L.-W.C., G.O.-C., E.G.F., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Caixa Research Institute, Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Neurology Service (E.G.F., J.D.), Hospital Clínic Barcelona; Pediatric Neuroimmunology Unit (E.G.F., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, University of São Paulo, Brazil; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Centro de Investigación Biomédica en Red (J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and University of Barcelona (J.D.), Barcelona, Spain
| | - Mateus Mistieri Simabukuro
- From the Group of Experimental Neuroimmunology (L.-W.C., G.O.-C., E.G.F., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Caixa Research Institute, Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Neurology Service (E.G.F., J.D.), Hospital Clínic Barcelona; Pediatric Neuroimmunology Unit (E.G.F., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, University of São Paulo, Brazil; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Centro de Investigación Biomédica en Red (J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and University of Barcelona (J.D.), Barcelona, Spain
| | - Takahiro Iizuka
- From the Group of Experimental Neuroimmunology (L.-W.C., G.O.-C., E.G.F., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Caixa Research Institute, Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Neurology Service (E.G.F., J.D.), Hospital Clínic Barcelona; Pediatric Neuroimmunology Unit (E.G.F., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, University of São Paulo, Brazil; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Centro de Investigación Biomédica en Red (J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and University of Barcelona (J.D.), Barcelona, Spain
| | - Thais Armangue
- From the Group of Experimental Neuroimmunology (L.-W.C., G.O.-C., E.G.F., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Caixa Research Institute, Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Neurology Service (E.G.F., J.D.), Hospital Clínic Barcelona; Pediatric Neuroimmunology Unit (E.G.F., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, University of São Paulo, Brazil; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Centro de Investigación Biomédica en Red (J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and University of Barcelona (J.D.), Barcelona, Spain
| | - Josep Dalmau
- From the Group of Experimental Neuroimmunology (L.-W.C., G.O.-C., E.G.F., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Caixa Research Institute, Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Neurology Service (E.G.F., J.D.), Hospital Clínic Barcelona; Pediatric Neuroimmunology Unit (E.G.F., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, University of São Paulo, Brazil; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Centro de Investigación Biomédica en Red (J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and University of Barcelona (J.D.), Barcelona, Spain
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Kvam KA, Stahl JP, Chow FC, Soldatos A, Tattevin P, Sejvar J, Mailles A. Outcome and Sequelae of Autoimmune Encephalitis. J Clin Neurol 2024; 20:3-22. [PMID: 38179628 PMCID: PMC10782092 DOI: 10.3988/jcn.2023.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 01/06/2024] Open
Abstract
Autoimmune etiologies are a common cause for encephalitis. The clinical syndromes consistent with autoimmune encephalitis are both distinct and increasingly recognized, but less is known about persisting sequelae or outcomes. We searched PubMed for reports on outcomes after autoimmune encephalitis. Studies assessing validated, quantitative outcomes were included. We performed a narrative review of the published literature of outcomes after autoimmune encephalitis. We found 146 studies that produced outcomes data. The mortality rates were 6%-19% and the relapse risks were 10%-62%. Most patients achieved a good outcome based on a score on the modified Rankin Scale (mRS) of ≤2. Forty-nine studies evaluated outcomes beyond mRS; these studies investigated cognitive outcome, psychiatric sequelae, neurological deficits, global function, and quality-of-life/patient-reported outcomes using various tools at varying time points after the index hospital discharge. These more-detailed assessments revealed that most patients had persistent impairments, with frequent deficits in cognitive function, especially memory and attention. Depression and anxiety were also common. Many of these sequelae continued to improve over months or even years after the acute illness. While we found that lasting impairments were common among survivors of autoimmune encephalitis, additional research is needed to better understand the nature and impact of these sequelae. Standardized evaluation protocols are needed to improve the ability to compare outcomes across studies, guide rehabilitation strategies, and inform outcomes of interest in treatment trials as the field advances.
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Affiliation(s)
- Kathryn A Kvam
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, Stanford University, Stanford, CA, USA.
| | | | - Felicia C Chow
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - James Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexandra Mailles
- Department of Infectious Diseases, Santé publique France, Saint-Maurice, France
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Wu PY, Chi CS, Tsai CR, Yang YL, Lee HF. Long-Term Outcome of Pediatric Patients with Anti-NMDA Receptor Encephalitis in a Single Center. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020182. [PMID: 36832312 PMCID: PMC9954979 DOI: 10.3390/children10020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is the most common autoimmune encephalitis in children. There is a high probability of recovery if treated promptly. We aimed to analyze the clinical features and long-term outcomes of pediatric patients with anti-NMDA receptor encephalitis. METHOD We conducted a retrospective study with definite diagnoses of anti-NMDA receptor encephalitis in 11 children treated in a tertiary referral center between March 2012 and March 2022. Clinical features, ancillary tests, treatment, and outcomes were reviewed. RESULTS The median age at disease onset was 7.9 years. There were eight females (72.7%) and three males (27.3%). Three (27.3%) patients initially presented with focal and/or generalized seizures and eight (72.7%) with behavioral change. Seven patients (63.6%) revealed normal brain MRI scans. Seven (63.6%) had abnormal EEG results. Ten patients (90.1%) received intravenous immunoglobulin, corticosteroid, and/or plasmapheresis. After a median follow-up duration of 3.5 years, one patient was lost to follow-up at the acute stage, nine (90%) had an mRS ≤ 2, and only one had an mRS of 3. CONCLUSIONS With the early recognition of anti-NMDA receptor encephalitis based on its clinical features and ancillary tests, we were able to treat patients promptly with first-line treatment and achieve favorable neurological outcomes.
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Affiliation(s)
- Pei-Yu Wu
- Division of Pediatric Neurology, Children’s Medical Center, Taichung Veterans General Hospital, 1650, Taiwan Boulevard Sec. 4, Taichung 407, Taiwan
| | - Ching-Shiang Chi
- Division of Pediatric Neurology, Children’s Medical Center, Taichung Veterans General Hospital, 1650, Taiwan Boulevard Sec. 4, Taichung 407, Taiwan
| | - Chi-Ren Tsai
- Division of Pediatric Neurology, Children’s Medical Center, Taichung Veterans General Hospital, 1650, Taiwan Boulevard Sec. 4, Taichung 407, Taiwan
| | - Yao-Lun Yang
- Division of Pediatric Neurology, Children’s Medical Center, Taichung Veterans General Hospital, 1650, Taiwan Boulevard Sec. 4, Taichung 407, Taiwan
| | - Hsiu-Fen Lee
- Division of Pediatric Neurology, Children’s Medical Center, Taichung Veterans General Hospital, 1650, Taiwan Boulevard Sec. 4, Taichung 407, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, 250, Kuo Kuang Rd., Taichung 402, Taiwan
- Correspondence:
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Dalmau J, Dalakas MC, Kolson DL, Paul F, Sánchez-Valle R, Zamvil SS. N2 Year in Review. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/1/e200076. [PMID: 36596717 PMCID: PMC9827124 DOI: 10.1212/nxi.0000000000200076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Josep Dalmau
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco.
| | - Marinos C Dalakas
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Dennis L Kolson
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Friedemann Paul
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Raquel Sánchez-Valle
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Scott S Zamvil
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
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