Heterogenous treatment for anti-NMDAR encephalitis in children leads to different outcomes 6-12 months after diagnosis

Kullasate Sakpichaisakul; Lucksanai Patibat; Thanin Wechapinan; Somjit Sri-Udomkajrorn; Metha Apiwattanakul; Sirorat Suwannachote

doi:10.1016/j.jneuroim.2018.09.007

Heterogenous treatment for anti-NMDAR encephalitis in children leads to different outcomes 6-12 months after diagnosis

J Neuroimmunol. 2018 Nov 15:324:119-125. doi: 10.1016/j.jneuroim.2018.09.007. Epub 2018 Sep 19.

Authors

Kullasate Sakpichaisakul¹, Lucksanai Patibat¹, Thanin Wechapinan¹, Somjit Sri-Udomkajrorn¹, Metha Apiwattanakul², Sirorat Suwannachote³

Affiliations

¹ Division of Neurology, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Ministry of Public Health, College of Medicine, Rangsit University, Bangkok, Thailand.
² Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand.
³ Division of Neurology, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Ministry of Public Health, College of Medicine, Rangsit University, Bangkok, Thailand. Electronic address: sirorat.s@rsu.ac.th.

PMID: 30269038
DOI: 10.1016/j.jneuroim.2018.09.007

Abstract

Recommended first line treatment in anti-NMDAR encephalitis includes steroids, IVIG, or plasma exchange. However, IVIG is non-reimbursable through Thailand's Universal Health Coverage. This study investigated outcomes from different treatments for anti-NMDAR encephalitis. Nineteen children in three treatments group: steroid alone, IVIG alone, and IVIG and steroid were reviewed. IVIG was administered to 13 (68%) and 6 (32%) only received steroids. Those receiving IVIG treatment with or without steroids had greater improvement in mRS at 6 (p = 0.04) and 12 months (p = 0.03). Such findings suggest the benefits of IVIG treatment for this condition despite the higher immediate cost.

Keywords: Anti-N-methyl-d-aspartate receptor encephalitis; Children; IVIG; Outcome.

Publication types

Observational Study

MeSH terms

Adolescent
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / blood
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnostic imaging*
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / epidemiology
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / therapy*
Child
Child, Preschool
Cohort Studies
Combined Modality Therapy / methods
Female
HEK293 Cells
Humans
Immunoglobulins, Intravenous / administration & dosage
Immunotherapy / methods
Infant
Male
Plasma Exchange / methods
Prospective Studies
Retrospective Studies
Steroids / administration & dosage
Thailand / epidemiology
Treatment Outcome

Substances

Immunoglobulins, Intravenous
Steroids