Relapse in pediatric anti-N-methyl-d-aspartate receptor encephalitis: A cohort study in one of the national children's medical center in China.
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PURPOSE: To retrospectively analyze the clinical characteristics and relapse factors of children with relapsed anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis in south China. METHODS: Clinical data of children diagnosed with relapsed anti-NMDAR encephalitis in Guangzhou Women and Children's Medical Center from October 2014 to June 2022 were collected. Patients with monophasic disease course in the same follow-up period were randomly selected as controls. Statistical analysis was performed using SPSS IBM 28.0 and figures were graphed using GraphPad Prism 7.01. RESULTS: A total of 18 children diagnosed with relapsed anti-NMDAR encephalitis (male: female 5:13). The initial onset age was (9.8 ± 3.1) year-old. Relapse interval was 7.0 [interquartile range (IQR) 6.5-15.0] months. Compared with relapses, neurological symptoms were more extensive and mRS scores were higher at the first episode (P = 0.000 in both). Female gender was an independent risk factor for relapse [odds ratio (OR) =0.055, 95 % confidence interval (CI): 0.003-0.907, P = 0.043]. Compared to the patients with monophasic disease course, the relapsed ones were prone to leave neurological sequelae (P = 0.011) at the last follow-up. CONCLUSIONS: Relapses often occur within 1 year after the first episode in children with anti-NMDAR encephalitis. Relapses were milder than first episodes. Female sex is an independent risk factor for relapses. The relapsed individuals were prone to leave neurological sequelae at the last follow-up.