Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis

Abstract

Autoimmune encephalitis (AE) can present like a psychiatric disorder. We aimed to illustrate the psychiatric manifestations, course and management of AE in a paediatric cohort. Neuropsychiatric symptoms, investigations and treatment were retrospectively retrieved in 16 patients (mean age 11.31, SD 2.98) with an AE diagnosis at the liaison psychiatry services in two UK tertiary paediatric centres. Psychiatric presentation was characterised by an acute polysymptomatic (predominantly agitation, anger outbursts/aggressiveness, hallucinations, and emotional lability) onset. Antipsychotics produced side effects and significant worsening of symptoms in four cases, and benzodiazepines were commonly used. This psychiatric phenotype should make clinicians suspect the diagnosis of AE and carefully consider use of treatments.

Anti-NMDAR encephalitis in a child with long impaired consciousness and persistent antibodies: a case report and mini review

“…While psychiatric manifestations are often considered a red flag, they may hold less significance in children. This could be attributed to biological factors or technical limitations ( 15 , 16 ). The psychopathological features of anti-NMDAR encephalitis are intricate, with some overlapping with neurological symptoms, particularly challenging in pediatric evaluations.…”

Refractory depressive disorder as the first manifestation of adolescent Sjögren’s syndrome, successfully treated with rituximab

“…The prevalence of CNS involvement in Gougerot-Sjögren’s syndrome reported in the literature varied considerably between 2.5 and 60%, which could be explained by the international variability of diagnostic criteria and the non-specificity of symptoms [ 2 , 3 ] . These neuropsychiatric manifestations vary greatly, including neurological deficits as well as psychiatric disorders, notably behavioural, mood or personality changes, sleep problems, cognitive dysfunction and psychotic symptoms [ 3 , 4 ] . Depression is quite common in adults with Sjögren’s syndrome, with a prevalence estimated in a meta-analysis between 8.33 and 75.56% [ 5 ] .…”

Sjogren’s syndrome related autoimmune encephalopathy presenting as depression and involuntary agitation in a 15-year-old girl: a case report

“…After immunosuppressant therapy with steroid and rituximab, her symptoms were relieved. Children and adolescents with autoimmune encephalitis commonly experience neuropsychiatric symptoms including behavioral, mood, or personality changes; sleep problems; cognitive dysfunction; and psychotic symptoms (11).…”

“…beginning of the clinical course. Seizures are a neurological presentation in children with autoimmune encephalitis (11). Although well-recognized, goal-directed ictal behavior is not common, Shih et al described a rare case of a patient who presented with complex motor interaction and vocal features during a frontal lobe seizure (15).…”