Language
English
Publication Date
10-1-2024
Journal
Pediatric Neurology
DOI
10.1016/j.pediatrneurol.2024.07.009
PMID
39094249
PMCID
PMC11381152
PubMedCentral® Posted Date
10-1-2025
PubMedCentral® Full Text Version
Author MSS
Abstract
Background: Isolated psychiatric symptoms can be the initial symptom of pediatric anti-N-methyl-d-aspartate (NMDA) receptor autoimmune encephalitis (pNMDARE). Here we report on the prevalence of isolated psychiatric symptoms in pNMDARE. We also assess whether initial neurodiagnostic tests (brain magnetic resonance imaging [MRI], electroencephalography [EEG], and/or cerebrospinal fluid [CSF] white blood cell count) are abnormal in children with isolated psychiatric symptoms and pNMDARE.
Methods: This multicenter retrospective cohort study from CONNECT (Conquering Neuroinflammation and Epilepsies Consortium) from 14 institutions included children under age 18 years who were diagnosed with pNMDARE. Descriptive statistics using means, medians, and comparisons for continuous versus discrete data was performed.
Results: Of 249 children included, 12 (5%) had only psychiatric symptoms without other typical clinical features of autoimmune encephalitis at presentation. All but one (11 of 12 = 92%) had at least one abnormal finding on initial ancillary testing: eight of 12 (67%) had an abnormal EEG, six of 12 (50%) had an abnormal MRI, and five of 12 (42%) demonstrated CSF pleocytosis. The single patient with a normal MRI, EEG, and CSF profile had low positive CSF NMDA antibody (titer of 1:1), and symptoms improved without immunotherapy.
Conclusions: Isolated first-episode psychiatric symptoms in pNMDARE are uncommon, and the majority of children will exhibit additional neurodiagnostic abnormalities. Delaying immunotherapy in a child with isolated psychiatric symptoms and normal neurodiagnostic testing may be warranted while awaiting confirmatory antibody testing.
Keywords
Humans, Anti-N-Methyl-D-Aspartate Receptor Encephalitis, Child, Male, Female, Retrospective Studies, Adolescent, Electroencephalography, Magnetic Resonance Imaging, Mental Disorders, Child, Preschool, Anti-NMDA receptor encephalitis, Anti-NMDAR encephalitis, Anti-NMDARE, Autoimmune encephalitis, Encephalitis, Pediatric autoimmune encephalitis
Published Open-Access
yes
Recommended Citation
Gombolay, Grace; Brenton, J Nicholas; Yang, Jennifer H; et al., "Isolated Psychiatric Symptoms in Children With Anti-N-Methyl-d Aspartate Receptor Encephalitis" (2024). Faculty and Staff Publications. 5889.
https://digitalcommons.library.tmc.edu/baylor_docs/5889