Long-term neuropsychological outcome following pediatric anti-NMDAR encephalitis.
Long-term neuropsychological outcome following pediatric anti-NMDAR encephalitis.
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DOI：
10.1212/wnl.0000000000005605
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发表时间：
2018-05-29
期刊：
影响因子：
9.9
通讯作者：
CHANCE Study Group
中科院分区：
文献类型：
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作者：
de Bruijn MAAM;Aarsen FK;van Oosterhout MP;van der Knoop MM;Catsman-Berrevoets CE;Schreurs MWJ;Bastiaansen DEM;Sillevis Smitt PAE;Neuteboom RF;Titulaer MJ;CHANCE Study Group
提供儿童和青少年抗 N-甲基-D-天冬氨酸受体（抗 NMDAR）脑炎后详细的长期结果数据，识别神经心理障碍，并评估这些因素对生活质量 (QoL) 的影响。所有被诊断患有抗 NMDAR 脑炎的荷兰儿童均已被确认。目前年龄为 4 岁或以上的患者被纳入后续研究，包括到访我们的诊所进行详细访谈和标准化神经心理学评估。包括以下领域：注意力、记忆力、语言、执行功能、生活质量和疲劳。主要结果指标是持续注意力、长期言语记忆、生活质量、疲劳和工作记忆的 z 分数。其中包括二十八名患者。上次就诊时的儿童大脑表现类别中位数为 1（四分位数范围 1-2，范围 1-4），64% (18/28) 的患者始终恢复到之前的学校水平。长期随访研究的横断面部分纳入了 22 名患者。中位随访时间为 31 个月（四分位数范围 15-49，范围 5-91）。持续注意力（z = -2.10，95% 置信区间 = -2.71 至 -1.46，p < 0.0001）和疲劳（z = -0.96，95% 置信区间 = -1.64 至 -0.28，p = 0.008）存在问题。认知缺陷与生活质量无关，而疲劳与生活质量密切相关（r = 0.82，p < 0.0001）。尽管儿童抗 NMDAR 脑炎的随访通常报告为“良好”，但许多患者存在认知问题和疲劳，甚至直到青春期，导致学业成绩问题和生活质量降低。对于医生来说，必须意识到这些问题，在急性期和随访阶段为患者和护理人员提供有价值的建议，并考虑早期神经心理学咨询。
To provide detailed long-term outcome data of children and adolescents following pediatric anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis, to identify neuropsychological impairments, and to evaluate the influence of these factors on quality of life (QoL). All Dutch children diagnosed with anti-NMDAR encephalitis were identified. Patients currently aged 4 years or older were included in the follow-up study, consisting of a visit to our clinic for a detailed interview and a standardized neuropsychological assessment. The following domains were included: attention, memory, language, executive functioning, QoL, and fatigue. Primary outcome measures were z scores on sustained attention, long-term verbal memory, QoL, fatigue, and working memory. Twenty-eight patients were included. Median Pediatric Cerebral Performance Category at last visit was 1 (interquartile range 1–2, range 1–4), and 64% (18/28) of patients returned consistently to their previous school level. Twenty-two patients were included in the cross-sectional part of the long-term follow-up study. Median follow-up time was 31 months (interquartile range 15–49, range 5–91). There were problems with sustained attention (z = −2.10, 95% confidence interval = −2.71 to −1.46, p < 0.0001) and fatigue (z = −0.96, 95% confidence interval = −1.64 to −0.28, p = 0.008). Cognitive deficits were not correlated with QoL, while fatigue was strongly correlated with QoL (r = 0.82, p < 0.0001). Although follow-up is often reported as “good” following pediatric anti-NMDAR encephalitis, many patients have cognitive problems and fatigue, even up until adolescence, resulting in academic achievement problems and lower QoL. For physicians, it is essential to be aware of these problems, to provide valuable advice to patients and caregivers in the acute and follow-up phase, and to consider early neuropsychological counseling.