关键词: 自身免疫性脑炎, 脑炎后癫痫, 儿童

Abstract: Objective The current low risk of secondary epilepsy in children recovering from N-methyl-D-aspartate receptor （NMDAR） resistant encephalitis is poorly studied and under-recognized by most clinicians. A comparative study of children with anti-NMDAR encephalitis secondary to epilepsy and non-secondary to epilepsy was conducted to improve clinicians′ understanding of the clinical features and associated factors influencing anti NMDAR encephalitis and its secondary epilepsy. Methods A retrospective analysis was conducted on the clinical data of 50 children with confirmed anti-NMDAR encephalitis who visited the neurology department of Wuhan Children′s Hospital from January 2015 to January 2022. Based on whether the children had secondary epilepsy at the final follow-up，they were divided into the post-encephalitis epilepsy group （PE group） and the post encephalitis non-secondary epilepsy group（NO-PE group）. Poisson regression analysis was used for statistics. Results The incidence of post-encephalitis epilepsy was 8%（4/50）. The male-to-female ratio of 50 children was 0. 61∶1. The male-to-female ratio of children with secondary epilepsy was 1∶3. The clinical manifestations of anti-NMDAR encephalitis were diverse，with epilepsy being one of the most common clinical symptoms，accounting for 86%（43/50），of which 64%（32/50）were initiated by epilepsy. Among children with secondary epilepsy，75%（3/4）also had seizures as the first symptom and were more likely to have motor disorders left（50%（2/4））and decreased learning ability left（75%（3/4））. In terms of treatment，most children with encephalitis received immunotherapy，and 74% （37/50）of them were treated with antiepileptic drugs in the acute phase. The head imaging showed there was a statistically significant difference（P < 0. 05）between the PE group and the NO-PE group in subcortical involvement（75%（3/4）vs. 13%（6/46）），involvement of the basal ganglia area（50%（2/4）vs. 0%（0/46）），and electroencephalography showing the presence δ brush（50%（2/4））vs.（8. 7%（4/46））. Conclusion The clinical symptoms of children with anti-NMDAR encephalitis are diverse，and the incidence of secondary epilepsy is low. Antiepileptic drugs can promptly control seizures after progression to post encephalitis epilepsy，the children with head imaging showing subcortical involvement，basal ganglia area，and electroencephalogram suggesting the presence δ brush are more likely to develop secondary epilepsy.

Key words: autoimmune encephalitis, postencephalitic epilepsy, children