[P1-114] Treatment Variety and Clinical Outcomes in NMDA Encephalitis in Pediatric Population in Limited Resources in Northern Part of Thailand, Chiang Mai University Hospital
Antibody to NMDA receptor began testing in Thailand after the year 2010. Prior to that time, patients who had behavior change together with seizure and bizarre movement were diagnosed with encephalitis of unknown etiology. We retrospectively reviewed the management of patients who had NMDA encephalitis in our center. After 2010, patients received serum and CSF NMDA antibody exams. One from ten patients had co-incidental Japanese encephalitis and NMDA encephalitis. Nine patients had antibody positive in both serum and CSF. Ten patients had brain CT and eight patients had brain MRI. Most of the patients had normal brain imaging. Ten of eleven had EEG studies primarily showing background slowing but no frontal delta brushes. Nine patients had IVMP plus IVIG during their acute phase with one patient had additional plasma exchange. Nine from ten patients had neither ovarian nor testicular tumors. The follow up period ranged from 17- 107 months. One patient received two courses of IVMP plus IVIG six months apart. One patient had eleven total intermittent IVIG courses interspersed with three failed courses of monthly cyclophosphamide and a rash during rituximab skin testing. Of ten patients; three did not receive oral immunosuppressive medication, one received short course prednisolone, three received prednisolone plus azathioprine and two received azathioprine during the follow up phase. Regarding the outcomes; one patient died from autonomic disturbance, one had uncontrolled epilepsy and none had significant aggressive behavior in their last follow up. The treatment scheme in NMDA encephalitis needs to be adjusted individually.