Page 123 - Ebook-Book JCMS 2025

Long-term Outcome of Anti-NMDA Receptor Encephalitis in
Thai Children
Thitirat Tosakulsak1*, Lunliya Thampratankul1, Chaiyos Khongkhatithum1, Kingthong Anurat1
,
Rapeepat Thewamit1, Phisitphon Ounchokdee1, Kullasate Sakpichaisakul2, Nuengjit Rojanawatsirivej2
,
Vitchayaporn Emarach Saengow3, Paneeta Panjanya3
1 Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
2 Queen Sirikit National Institute of Child Health
3 Maharat Nakhon Ratchasima Hospital
*Corresponding Author E-mail: thytynew@gmail.com
Background: Methods: Abstract
Previous studies showed that 80-90% of patients with Anti-NMDA receptor encephalitis
(Anti-NMDARE) had good short-term outcomes, but data on long-term outcomes were
limited. This study aims to evaluate the long-term outcome of Anti-NMDARE in Thai
children and the factors associated with the outcome.
This is a multi-center cross-sectional study that included patients diagnosed with anti-
NMDARE aged ≤ 18 years and followed up at Ramathibodi Hospital, Queen Sirikit National
Institute of Child Health, and Maharat Nakhon Ratchasima Hospital for at least 5 years.
Clinical characteristics, investigation, diagnosis of epilepsy, and treatment were
retrospectively reviewed. Modified Rankin scale (mRS) and Child Behavior Checklist for
ages 6-18 (CBCL) were evaluated after informed consent. Good functional neurological
outcome was determined as having a mRS ≤ 2.
Results: Conclusion: Eighty patients met the inclusion criteria; 7 (8.75%) died, 28 (35%) lost to follow-up,
and 45 were included (75.56% female, age at diagnosis 8.81± 3.91 years, and follow-up
duration 8.45 ± 2.54 years). At the last follow-up, 43 patients (95.56%) had good functional
neurological outcomes. Thirty-six were diagnosed with epilepsy, and treatment can be
discontinued in 29 (80.56%). Among 28 patients aged 6-18 years, CBCL showed that
14 (50%) had borderline/abnormal total syndrome score. Somatic complaints (35.71%)
thought problems (32.14%), anxious/depressed (21.43%), and attention problems (21.43%)
were mostly affected. Forty-one patients (91.1%) can return to school/work. Factors
significantly associated with not going to school/work were mRS at 5 years, abnormal
CBCL in syndromes of attention problems, and social problems.
Most patients with anti-NMDARE had good long-term outcomes in terms of functional
neurological status and epilepsy and could return to school/work. However, half of them
had behavior and emotional problems that might affect their academic and work activities.
Therefore, screening and management of behavior and emotional problems in these
patients with Anti-NMDARE, even in the remission phase, are warranted.
Harmony in health: Innovation for Sustainable Medicine
121