Pediatric autoimmune encephalitis: Recognition and diagnosis.

Autor:	de Bruijn MAAM; From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague., Bruijstens AL; From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague., Bastiaansen AEM; From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague., van Sonderen A; From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague., Schreurs MWJ; From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague., Sillevis Smitt PAE; From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague., Hintzen RQ; From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague., Neuteboom RF; From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague., Titulaer MJ; From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague. m.titulaer@erasmusmc.nl.
Jazyk:	angličtina
Zdroj:	Neurology(R) neuroimmunology & neuroinflammation [Neurol Neuroimmunol Neuroinflamm] 2020 Feb 11; Vol. 7 (3). Date of Electronic Publication: 2020 Feb 11 (Print Publication: 2020).
DOI:	10.1212/NXI.0000000000000682
Abstrakt:	Objective: The aims of this study were (1) to describe the incidence of autoimmune encephalitis (AIE) and acute disseminated encephalomyelitis (ADEM) in children, (2) to validate the currently used clinical criteria to diagnose AIE, and (3) to describe pitfalls in the diagnosis of pediatric autoimmune (AI) and inflammatory neurologic disorders. Methods: This study cohort consists of 3 patient categories: (1) children with antibody-mediated AIE (n = 21), (2) children with ADEM (n = 32), and (3) children with suspicion of an AI etiology of their neurologic symptoms (n = 60). Baseline and follow-up clinical data were used to validate the current guideline to diagnose AIE. In addition, patient files and final diagnoses were reviewed. Results: One-hundred three of the 113 included patients fulfilled the criteria of possible AIE. Twenty-one children had antibody-mediated AIE, of whom 19 had anti-N-methyl-D-aspartate receptor (NMDAR), 1 had anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, and 1 had anti-leucine-rich glioma-inactivated protein 1 encephalitis. Finally, 34 children had ADEM, and 2 children had Hashimoto encephalopathy. Mean incidence rates were 1.54 children/million (95% CI 0.95-2.35) for antibody-mediated AIE and 2.49 children/million (95% CI 1.73-3.48) for ADEM. Of the other 48 children, treating physicians' diagnoses were reviewed. In 22% (n = 6) of children initially diagnosed as having an AI/inflammatory etiology (n = 27), no support for AI/inflammation was found. Conclusion: Besides anti-NMDAR encephalitis and ADEM, other AIEs are rare in children. The current guideline to diagnose AIE is also useful in children. However, in children with nonspecific symptoms, it is important to review data critically, to perform complete workup, and to consult specialized neuroinflammatory centers. (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)
Databáze:	MEDLINE
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