YẾU TỐ LIÊN QUAN ĐÁP ỨNG KÉM VỚI CORTICOID Ở BỆNH NHI ĐƯỢC CHẨN ĐOÁN VIÊM NÃO TỰ MIỄN LẦN ĐẦU

Abstract

Background: Corticosteroids are the first-line immunotherapy for autoimmune encephalitis (AE) in children. Early prediction of treatment response is essential for selecting optimal therapeutic strategies and improving patient outcomes. Methods: A retrospective study was conducted on 85 pediatric patients newly diagnosed with AE at Children’s Hospital 2, from January 2021 to June 2024, based on Cellucci criteria. Clinical outcomes were assessed using the Clinical Assessment Scale for Autoimmune Encephalitis (CASE) at baseline, 1–2 weeks post-treatment, and after 3 months of follow-up. Results: 70.6% of patients showed improvement in CASE scores after 1–2 weeks of corticosteroid therapy; 25.9% required additional immunotherapy (IVIG, plasmapheresis, or rituximab). The overall corticosteroid response rate for 3 months was 68%. Patients with poor response had significantly higher rates of cognitive impairment (96.3% vs. 75.9%, p=0.03), consciousness disorders (70.4% vs. 44.8%, p=0.028), motor dysfunction (85.2% vs. 50%, p=0.002), and elevated cerebrospinal fluid (CSF) lactate levels (p=0.017). Conclusions: Clinical features such as consciousness disturbance, speech impairment, motor dysfunction, higher initial CASE scores, and elevated CSF lactate are associated with poor corticosteroid response in children with AE. These indicators may aid in early identification of patients requiring escalated immunotherapy.