Pediatric autoimmune encephalitis: a review

Authors

  • Bipesh K. Shah Department of Pediatrics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
  • Arun K. Singh Department of Pediatrics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

DOI:

https://doi.org/10.18203/2349-3291.ijcp20240745

Keywords:

Antibodies, Autoimmune, Encephalitis, Immunotherapy

Abstract

Autoimmune encephalitis has been an emerging disease in the pediatric age group for the last few years. It is of utmost importance to recognize the disease for the timely initiation of immunotherapy. The antibody-mediated encephalitis should be considered in the differentials apart from vasculitic, metabolic encephalopathy after ruling out bacterial, viral, tubercular, parasitic, and rickettsial causes. It can even coexist with herpes encephalitis in a quarter of the cases. The prodromal symptoms and progression to psychiatric, memory, speech disturbance, movement disorder, altered mental status, dysautonomia, and seizures within a span of a month characterize the disease. The approach to diagnosis involves various antibody testing in serum and cerebrospinal fluid along with brain imaging and electroencephalography. Early treatment with steroids, intravenous immunoglobulin, and plasmapheresis leads to better outcomes. A literature search was made using keywords in the Google Scholar and Pubmed databases before January 2024. The collected materials were reviewed for appropriate titles and content focusing on diagnosis and management. The article aims to provide a comprehensive review regarding the differential diagnosis and management of autoimmune encephalitis in children.

 

References

De Bruijn MAAM, Bruijstens AL, Bastiaansen AEM, Van Sonderen A, Schreurs MWJ, Sillevis Smitt PAE, et al. Pediatric autoimmune encephalitis: Recognition and diagnosis. Neurol - Neuroimmunol Neuroinflammation. 2020;7(3):e682.

Hardy D. Autoimmune Encephalitis in Children. Pediatr Neurol. 2022;132:56-66.

Agarwal R, Gupta V. Anti-NMDAR Encephalitis in Children. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.

Yang J, Li Y, Luo H, Ma J, Zheng Y, Zhou L, et al. Elevated serum levels of the NLRP3 inflammasome are associated with the severity of anti-NMDAR encephalitis in children. Clin Chim Acta. 2023;551:117587.

Cellucci T, Van Mater H, Graus F, Muscal E, Gallentine W, Klein-Gitelman MS, et al. Clinical approach to the diagnosis of autoimmune encephalitis in the pediatric patient. Neurol Neuroimmunol Neuroinflammation. 2020;7(2):e663.

Garg D, Mohammad SS, Sharma S. Autoimmune Encephalitis in Children: An Update. Indian Pediatr. 2020;57(7):662-70.

Suthar R, Saini AG, Sankhyan N, Sahu JK, Singhi P. Childhood Anti-NMDA Receptor Encephalitis. Indian J Pediatr. 2016;83(7):628-33.

Nosadini M, Thomas T, Eyre M, Anlar B, Armangue T, Benseler SM, et al. International Consensus Recommendations for the Treatment of Pediatric NMDAR Antibody Encephalitis. Neurol - Neuroimmunol Neuroinflammation. 2021;8(5):e1052.

Castillo Rocha PA, Hon KLE, Mohanty M, Torres AR. Autoimmune encephalitis in pediatric population. Medicina (Mex). 2022;82(3):46-50.

Banwell B, Bennett JL, Marignier R, Kim HJ, Brilot F, Flanagan EP, et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol. 2023;22(3):268-82.

Salama S, Khan M, Pardo S, Izbudak I, Levy M. MOG antibody–associated encephalomyelitis/ encephalitis. Mult Scler J. 2019;25(11):1427-33.

Wegener-Panzer A, Cleaveland R, Wendel EM, Baumann M, Bertolini A, Häusler M, et al. Clinical and imaging features of children with autoimmune encephalitis and MOG antibodies. Neurol - Neuroimmunol Neuroinflammation. 2020;7(4):e731.

Song X, Ma J. Clinical characteristics of myelin-oligodendrocyte glycoprotein antibody-positive pediatric autoimmune encephalitis without demyelination: A case series. Front Immunol. 2022 Dec 1;13:1050688.

Wu L, Cai F, Zhuo Z, Wu D, Zhang T, Yang H, et al. CASPR2 antibody associated neurological syndromes in children. Sci Rep. 2023 Feb 6;13(1):2073.

Harmon A, Stingl C, Rikhi A, Tran L, Pizoli C, Malinzak M, et al. Pediatric GAD-65 Autoimmune Encephalitis: Assessing Clinical Characteristics and Response to Therapy With a Novel Assessment Scale. Pediatr Neurol. 2022;128:25-32.

Cay-Martinez KC, Hickman RA, McKhann Ii GM, Provenzano FA, Sands TT. Rasmussen Encephalitis: An Update. Semin Neurol. 2020;40(02):201-10.

Haberlandt E, Bast T, Ebner A, Holthausen H, Kluger G, Kravljanac R, et al. Limbic encephalitis in children and adolescents. Arch Dis Child. 2011;96(2):186-91.

Dai X, Kuang L, Feng L, Yi X, Tang W, Liao Q, et al. Anti-Dopamine Receptor 2 Antibody-Positive Encephalitis in Adolescent. Front Neurol. 2020;11:471.

Santoro JD, Lazzareschi DV, Campen CJ, Van Haren KP. Pediatric Bickerstaff brainstem encephalitis: a systematic review of literature and case series. J Neurol. 2018;265(1):141-50.

Messina G, Sciuto S, Fontana A, Greco F, Oliva CF, Pappalardo MG, et al. On clinical findings of Bickerstaff’s brainstem encephalitis in childhood. J Integr Neurosci. 2021;20(2):509.

Soto-Rincón CA, Castillo-Torres SA, Cantú-García DA, Estrada-Bellmann I, Chávez-Luévanos B, Marfil A. The poor insane Ophelia: reconsidering Ophelia syndrome. Arq Neuropsiquiatr. 2019;77(11):828-31.

Figlerowicz M, Kemnitz P, Mania A, Mazur-Melewska K, Tomczak E, Kuls K, et al. Autoimmune encephalitis with GABA A receptor antibodies in a 10-year-old girl. Clin Neurol Neurosurg. 2018;164:160-3.

Zhu F, Shan W, Lv R, Li Z, Wang Q. Clinical Characteristics of Anti-GABA-B Receptor Encephalitis. Front Neurol. 2020;11:403.

Uy CE, Binks S, Irani SR. Autoimmune encephalitis: clinical spectrum and management. Pract Neurol. 2021;21(5):412-23.

Fox K, Wells ME, Tennison M, Vaughn B. Febrile Infection-Related Epilepsy Syndrome (FIRES): A Literature Review and Case Study. Neurodiagnostic J. 2017;57(3):224-33.

Soler Wenglein J, Kluger G, Leypoldt F, Wandinger KP, Van Baalen A. No evidence of neuronal/glial autoantibodies in febrile infection-related epilepsy syndrome (FIRES): a prospective clinic-serologic analysis. Front Neurosci. 2023 Jul 13;17:1221761.

Mehta NP, Sawdy R, Maloney K, Overlee B, Johnson RK, Howe CL, et al. Intrathecal Dexamethasone in Febrile Infection–Related Epilepsy Syndrome: A Case Report. Neurol Clin Pract. 2023;13(3):e200153.

Koh S, Wirrell E, Vezzani A, Nabbout R, Muscal E, Kaliakatsos M, et al. Proposal to optimize evaluation and treatment of Febrile infection‐related epilepsy syndrome (FIRES): A Report from FIRES workshop. Epilepsia Open. 2021;6(1):62-72.

Teixeira AL, Vasconcelos LP, Nunes MDCP, Singer H. Sydenham’s chorea: from pathophysiology to therapeutics. Expert Rev Neurother. 2021;21(8):913-22.

Chain JL, Alvarez K, Mascaro-Blanco A, Reim S, Bentley R, Hommer R, et al. Autoantibody Biomarkers for Basal Ganglia Encephalitis in Sydenham Chorea and Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infections. Front Psychiatry. 2020;11:564.

Steinlin MI, Blaser SI, Gilday DL, Eddy AA, Logan WJ, Laxer RM, et al. Neurologic manifestations of pediatric systemic lupus erythematosus. Pediatr Neurol. 1995;13(3):191-7.

Hardin H, Shao W, Bernstein JA. An updated review of pediatric autoimmune neuropsychiatric disorders associated with Streptococcus/pediatric acute-onset neuropsychiatric syndrome, also known as idiopathic autoimmune encephalitis: What the allergist should know. Ann Allergy Asthma Immunol. 2023;131(5):567-75.

Sigra S, Hesselmark E, Bejerot S. Treatment of PANDAS and PANS: a systematic review. Neurosci Biobehav Rev. 2018;86:51-65.

Afolabi-Brown O, Mason TBA. Kleine-Levin Syndrome. Paediatr Respir Rev. 2018;25:9-13.

Takenoshita S, Sakai N, Chiba Y, Matsumura M, Yamaguchi M, Nishino S. An overview of hypocretin based therapy in narcolepsy. Expert Opin Investig Drugs. 2018;27(4):389-406.

Sabanathan S, Abdel‐Mannan O, Mankad K, Siddiqui A, Das K, Carr L, et al. Clinical features, investigations, and outcomes of pediatric limbic encephalitis: A multicenter study. Ann Clin Transl Neurol. 2022;9(1):67-78.

Zhang Y, Cheng Y, Yang C, Jin L, Li Y. Therapeutic plasma exchange in ANTI‐ N‐methyl‐D‐aspartate receptor encephalitis. Ther Apher Dial. 2023;27(2):197-206.

Stingl C, Cardinale K, Van Mater H. An Update on the Treatment of Pediatric Autoimmune Encephalitis. Curr Treat Options Rheumatol. 2018;4(1):14-28.

Randell RL, Adams AV, Van Mater H. Tocilizumab in Refractory Autoimmune Encephalitis: A Series of Pediatric Cases. Pediatr Neurol. 2018;86:66-8.

Gabilondo I, Saiz A, Galan L, Gonzalez V, Jadraque R, Sabater L, et al. Analysis of relapses in anti-NMDAR encephalitis. Neurology. 2011;77(10):996-9.

Downloads

Published

2024-03-27

Issue

Section

Review Articles