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Treatment and outcome of children and adolescents with N-methyl-D-aspartate receptor encephalitis.
- Source :
-
Journal of neurology [J Neurol] 2015 Aug; Vol. 262 (8), pp. 1859-66. Date of Electronic Publication: 2015 May 19. - Publication Year :
- 2015
-
Abstract
- The objective of this study is to describe the treatment and outcome of children and adolescents with N-methyl-D-aspartate receptor (NMDA-R) encephalitis. A retrospective study of children and adolescents with NMDA-R encephalitis was performed by the French Paraneoplastic Neurological Syndrome Reference Center between January 1, 2007 and December 31, 2012. The modified Rankin scale (mRS) was used to assess outcome. Thirty-six children and adolescents with NMDA-R encephalitis were studied. All of the patients received first-line immunotherapy (corticosteroids, intravenous immunoglobulins or plasma exchange), and 81% received second-line immunotherapy (rituximab or cyclophosphamide). Median time between first-line and second-line treatment was 26 days. During the first 24 months, 30 of 36 patients (83%) achieved a good outcome (mRS ≤ 2) and 20 of 36 patients (56%) achieved complete recovery (mRS = 0). Median time to good outcome and to complete recovery was 6 and 24 months, respectively. Three patients (8%) relapsed, one patient died. In multivariate analysis, age >12 years was a predictor of good outcome and initial mRS ≤ 3 was a predictor of complete recovery. Despite a higher rate of patients who received second-line immunotherapy, the outcome of the patients in the present series was very similar to the outcome reported in previous series. The present study highlights the need for clinical trials to determine the optimal treatment of NMDA-R encephalitis.
- Subjects :
- Adolescent
Age Factors
Anti-N-Methyl-D-Aspartate Receptor Encephalitis physiopathology
Child
Child, Preschool
Female
Humans
Infant
Male
Plasma Exchange methods
Prognosis
Retrospective Studies
Severity of Illness Index
Anti-N-Methyl-D-Aspartate Receptor Encephalitis therapy
Immunotherapy methods
Outcome Assessment, Health Care
Subjects
Details
- Language :
- English
- ISSN :
- 1432-1459
- Volume :
- 262
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of neurology
- Publication Type :
- Academic Journal
- Accession number :
- 25987208
- Full Text :
- https://doi.org/10.1007/s00415-015-7781-9