Symptomatic treatment of children with anti-NMDAR encephalitis
Symptomatic treatment of children with anti-NMDAR encephalitis
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DOI：
10.1111/dmcn.12882
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发表时间：
2016-04-01
影响因子：
3.8
通讯作者：
Dale, Russell C.
中科院分区：
文献类型：
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作者：
Mohammad, Shekeeb S.;Jones, Hannah;Dale, Russell C.
AimWe首次对抗n -甲基-d-天冬氨酸受体（NMDAR）脑炎患儿进行了症状管理的获益和不良反应的研究。方法对澳大利亚和新西兰两所三级儿科医院进行回顾性图表分析。我们纳入了27名儿童（男12名，女15名，入院时平均年龄7 ~ 1个月），血清或脑脊液中有抗nmdar抗体，并有典型的临床综合征。结果27例患者中只有2例是白人，而27例患者中有16例是太平洋岛屿/新西兰毛利人。平均入院时间为69天（10-224天），48%的患者（13/27）需要在重症监护环境中治疗。每位患者平均使用8种药物进行症状治疗。治疗的症状有躁动（n=25）、癫痫发作（n=24）、运动障碍（n=23）、睡眠障碍（n=17）、精神症状（n=10）和自主神经异常（n= 4）。使用的药物包括5种不同的苯二氮卓类药物（n=25）， 7种抗惊厥药物（n=25）， 8种镇静和睡眠药物（n=23）， 5种抗精神病药物（n=12）和5种运动障碍药物（n=10）。除苯二氮卓类药物外，镇静和睡眠药物最有效，每次服药的平均获益为67.4%，每次服药的平均不良反应-获益比为0.04。抗精神病药物使用时间较短（中位为9d），每次服药的平均获益最低，为35.4%，每次服药的不良反应-获益比为2.0。长效苯二氮卓类药物、抗惊厥药和可乐定可治疗多种症状。抗nmdar脑炎患者易出现抗精神病相关不良反应。在我们地区，太平洋岛民似乎易患抗nmdar脑炎。
AimWe performed the first study on the perceived benefit and adverse effects of symptomatic management in children with anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis.MethodA retrospective chart review was undertaken at two tertiary paediatric hospitals in Australia and New Zealand. We included 27 children (12 males, 15 females; mean age at admission 7y 1mo) with anti-NMDAR antibodies in serum or cerebrospinal fluid with a typical clinical syndrome.ResultsOnly two out of 27 patients were white, whereas 16 out of 27 patients were from the Pacific Islands/New Zealand Maori. The mean duration of admission was 69days (10-224d) and 48% of patients (13/27) needed treatment in an intensive care setting. A mean of eight medications per patient was used for symptomatic management. Symptoms treated were agitation (n=25), seizures (n=24), movement disorders (n=23), sleep disruption (n=17), psychiatric symptoms (n=10), and dysautonomia (n=four). The medications used included five different benzodiazepines (n=25), seven anticonvulsants (n=25), eight sedatives and sleep medications (n=23), five antipsychotics (n=12), and five medications for movement disorders (n=10). Sedative and sleep medications other than benzodiazepines were the most effective, with a mean benefit of 67.4% per medication and a mean adverse effect-benefit ratio of 0.04 per medication. Antipsychotic drugs were used for a short duration (median 9d), and had the poorest mean benefit per medication of 35.4% and an adverse effect-benefit ratio of 2.0 per medication.InterpretationLong-acting benzodiazepines, anticonvulsants, and clonidine can treat multiple symptoms. Patients with anti-NMDAR encephalitis appear vulnerable to antipsychotic-related adverse effects. Pacific Islanders appear to have a vulnerability to anti-NMDAR encephalitis in our region.