ĐẶC ĐIỂM VIÊM NÃO KHÁNG NMDAR Ở TRẺ EM ĐƯỢC ĐIỀU TRỊ THAY HUYẾT TƯƠNG TẠI BỆNH VIỆN NHI ĐỒNG 2

Abstract

Objective: to describe characteristics of children diagnosed with Anti-NMDAR encephalitis who were treated with therapeutic plasma exchange (TPE). Method: a retrospective case series, conducted on patients diagnosed with Anti-NMDAR encephalitis underwent TPE treatment at Children's Hospital No. 2, between January 2019 and June 2022. Results: a total of 32 patients were enrolled in the study, 18 in the Anti-NMDAR encephalitis group and 14 in the probable antibody-negative autoimmune encephalitis group. The Anti-NMDAR encephalitis group had a male to female ratio of 1:2.6 and a median age of 7 (4.5-12.3) years old. The median duration from onset to hospital admission was 8.5 (4-14) days. The majority (89.9%) of the Anti-NMDAR encephalitis group had severe encephalitis with symptoms including altered consciousness (100%), psychosis (94.4%), speech impairment (94.4%), seizure (83.3%), and movement disorders (100%). The Anti-NMDAR group also showed a higher frequency of delusions, hyperactivity, and dyskinesias compared to the probable antibody-negative autoimmune encephalitis group. In terms of laboratory evaluation, 83.3% of Anti-NMDAR encephalitis cases showed abnormal cerebrospinal fluid (CSF) results, with a higher white blood cell count and rate of leukocytosis compared to the other group. EEG showed abnormalities in 75% of cases and brain MRI results showed abnormalities in 33.3% of cases. In terms of treatment, 5.6% received TPE monotherapy, 83.3% received IVMT+TPE, and 11.1% received IVMT+TPE+ IVIG. 77.8% of cases showed improvement after treatment, with a median length of hospital stay of 39 days. Conclusions: severe Anti-NMDAR encephalitis patients typically showed symptoms of altered consciousness, neuropsychiatric, language deficits, and dyskinetic movements. Severe cases of Anti-NMDAR encephalitis had a higher rate of treatment response, and the combination of IVMT + TPE was effective in improving patient outcomes.