Anti-N-methyl-D-aspartate receptor encephalitis with demyelinated lesions in 3 children and literature review / 中华实用儿科临床杂志

ABSTRACT

Objective To summarize the clinical and prognostic features of anti - N - methyl - D - aspartate receptor (NMDAR)encephalitis with demyelinated lesions and discuss the possible pathogenesis. Methods The clini-cal and imaging features of 3 pediatric patients diagnosed as anti - NMDAR encephalitis with demyelinated lesions were analyzed. The published papers were browsed by using " anti - NMDA receptor encephalitis" and " demyelinating"as key words into CNKI,Wanfang and PubMed database from starting point to May,2017. Results In 3 cases,anti -NMDAR encephalitis occurred simultaneously with demyelinated episodes in 2 cases,successively in the other case. One case had AQP4 - IgG positive. Two cases had recurrent course,and 1 case had a single course and poor prognosis. A to-tal of 15 articles reported 41 cases,including 16 (39. 02％)pediatric cases. In these pediatric cases,anti - NMDAR encephalitis occurred in 7 cases (43. 75％)successively and demyelinated episodes occurred in 9 cases (56. 25％) simultaneously. AQP4 antibody and MOG antibody in serum and/ or cerebrospinal fluid were detected in all cases,with either of two antibodies positive in 9 cases (56. 25％). Conclusion Anti - NMDAR encephalitis might occur simulta-neously or successively with demyelinated episodes. Compared with typical patients with anti - NMDAR encephalitis, patients with demyelinated lesions are more likely to relapse and have worse outcomes. Anti - NMDAR encephalitis and demyelinated lesions are both based on similar immune dysfunction or demyelinated lesions are also induced by anti -NMDAR antibodies,which is the probable pathogenesis.