Abstract Autoimmune encephalitis is rare and has various clinical manifestations, which may hamper the correct diagnosis. Therefore, the pediatrician should be familiar with the clinical symptoms, signs, laboratory features, neuroimaging changes, immunological characteristics, and differential diagnosis of this disease. In order to correctly diagnose anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, cerebrospinal fluid (CSF) examinations including detection of oligoclonal bands, brain MRI scanning, and routine EEG and/or 24 hours video EEG should be performed in children. For highly suspected cases, particularly children presenting with psychiatric symptoms and epileptic seizures, examinations should be done to detect anti-NMDAR antibodies (Abs) in serum and CSF. A notable feature in children is the EEG pattern named "extreme delta brush", which may help confirm the clinical diagnosis. Anti-NMDAR Abs in CSF is the diagnostic "gold-standard" for this disease. The differential diagnosis of anti-NMDAR encephalitis is broad. In pediatric patients, the differential diagnosis should be made mainly with herpes simplex virus encephalitis, other autoimmune encephalitis, and psychosis.
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Cite this article:
WANG Hua. Diagnosis and differential diagnosis of anti-N-methyl-D-aspartate receptor encephalitis in children[J]. CJCP, 2014, 16(6): 578-583.
WANG Hua. Diagnosis and differential diagnosis of anti-N-methyl-D-aspartate receptor encephalitis in children[J]. CJCP, 2014, 16(6): 578-583.
Demaerel P, Van Dessel W, Van Paesschen W, et al. Autoimmune-mediated encephalitis[J].Neuroradioalogy, 2011, 53(11): 837-851.
[2]
Ferioli S, Dalmau J, Kobet CA, et al. Anti-N-methyl-D-aspartate receptor encephalitis: characteristic behavioral and movement disorder[J].Arch Neurol, 2101, 67(2): 250-251.
[3]
Suh-Lailam BB, Haven TR, Copple SS, et al. Anti-NMDAreceptorantibody encephalitis: performance evaluation and laboratory experance with the anti-NMDA-receptor IgG assay[J].Clin Chim Acta, 2013, 421: 1-6.
[4]
Thomas L, Mailles A, Desestret V, et al. Autoimmune N-methyl- D-aspartate receptor encephalitis is a differential diagnosis of infectious encephalitis[J].J Infect, 2014, 68(5): 419-425.
[5]
Shiho Takano S, Takahashi T, Kishi H, et al. Detection of autoantibody against extracellular epitopes of N-methyl-D-aspartate receptor by cell-based assay[J].Neurosci Res, 2011, 71(2): 294- 302.
[6]
Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series andanalysis of the effects of antibodys[J].Lancet Neurol, 2008, 7(12): 1091-1098.
Armangue T, Titulaer MJ, Málaga I, et al. Pediatric anti-N-methyl- D-aspartate receptor encephalitis-clinical analysis and novel findings in a series of 20 patients[J].J Pediatr, 2013, 162(4): 850- 856.
[9]
Malter MP, Elger CE, Surges R. Diagnostic value of CSF fidings in antibody-associated limbic and anti-NMDAR-encephalitis[J].Seizure, 2013, 22(1): 136-140.
[10]
Schmitt SE, Pargeon K, Frechette ES, et al. Extreme delta brush: A unique EEG pattern in adults with anti-NMDA receptor encephalitis[J].Neurology, 2012, 79(11): 1094-1100.
[11]
Leypoldt F, Buchert R, Kleiter I, et al. Fluorodeoxyglucose positron emission tomography in anti-NMDA receptor encephalitis: distinct pattern of disease[J].J Neurol Neurosurg Psychitr, 2012, 83(7): 681-686.
[12]
Dalmau J, Tuzun E, Wu HY, et al. Paraneoplastic anti-Nmethyl- D-aspartate receptoe encephalitis associated with ovarian teretoma[J].Ann neurology, 2007, 61(1): 25-36.
[13]
Yau ML, Fung EL. Early consideration of anti-NMDAR encephalitis in unexplained encephalopathy[J].Hong Kong Med J, 2013, 19(4): 362-364.
