Diagnosis of pediatric anti-NMDAR encephalitis at the onset: A clinical challenge

F Ursitti, D Roberto, L Papetti, R Moavero, M A N Ferilli, L Fusco, F Vigevano, P Curatolo, M Valeriani

Research output: Contribution to journalArticlepeer-review


BACKGROUNDS: To investigate the clinical and instrumental features at the onset addressing to the diagnosis of anti-NMDAR encephalitis.

METHODS: Twenty children (age: 15 months-17 years; 7 males, 13 females) with initial suspected diagnosis of autoimmune encephalitis, observed between January 2008 and March 2018, were included. The final diagnosis was anti-NMDAR encephalitis in 7 children, other/probable autoimmune encephalitis in 7 children, and primary psychosis in the remaining 6 children.

RESULTS: At the clinical onset, anxiety disorder was the main symptom that helped in distinguishing the group of psychotic children from children with non-infectious encephalitis (P = 0.05 OR = 0.001), while epileptic seizures strongly predicted anti-NMDAR encephalitis (P = 0.04 OR = 28.6). At the onset, anti-NMDAR encephalitis could be distinguished from other/probable autoimmune encephalitis for the presence of sleep/wake rhythm alteration (P = 0.05 OR = 15). Among the symptoms occurring during the hospitalization, movement disorders (P = 0.031 OR = 12) were predictive of non-infectious encephalitis rather than primary psychosis. More specifically, the occurrence of language impairment (P = 0.03 OR = 33), epileptic seizures (P = 0.04 OR = 28.6) and catatonia (P = 0.03, OR = 33), were predictive of anti-NMDAR encephalitis. Also at this stage, anxiety disorder (P = 0.03 OR = 0.033) was predictive of primary psychosis.

CONCLUSION: Our findings suggest that at the clinical onset epileptic seizures and sleep/wake rhythm alteration represent the main features addressing to the diagnosis of anti-NMDAR encephalitis rather than primary psychosis and other/probable autoimmune encephalitis, while anxiety disorder could be a solid predictor of primary psychosis.

Original languageEnglish
Pages (from-to)9-16
Number of pages8
JournalEuropean Journal of Paediatric Neurology
Publication statusPublished - Jan 2021


  • Adolescent
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications
  • Catatonia/etiology
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Movement Disorders/etiology
  • Psychotic Disorders/etiology
  • Seizures/etiology


Dive into the research topics of 'Diagnosis of pediatric anti-NMDAR encephalitis at the onset: A clinical challenge'. Together they form a unique fingerprint.

Cite this