Seongsik Son, Kil-Byung Lim, Jeehyun Yoo, Pamela Song, Jiyong Kim
{"title":"Cognitive Impairment in a Child With Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report.","authors":"Seongsik Son, Kil-Byung Lim, Jeehyun Yoo, Pamela Song, Jiyong Kim","doi":"10.12786/bn.2023.16.e12","DOIUrl":null,"url":null,"abstract":"<p><p>Anti-N-methyl-D-aspartate-receptor encephalitis is a complex autoimmune inflammatory neurological disorder that presents with epileptic seizures and rapid functional deterioration, including movement disorders and cognitive impairment, especially in young patients. Despite aggressive initial treatment with immune therapy, such as corticosteroids, intravenous immunoglobulin, and plasmapheresis, patients often need intensive rehabilitative therapies for their long-lasting deficits. We report a pediatric case of anti-N-methyl-D-aspartate receptor encephalitis in Korea that presented with symptoms of muscle weakness of the four extremities, dysarthria, dysphagia, and cognitive impairment in the acute phase. The patient underwent 4 weeks of comprehensive rehabilitative treatment, including physical therapy, occupational therapy, swallowing rehabilitation therapy, cognitive rehabilitation therapy, and speech therapy. At the follow-up evaluation after 4 weeks of treatment, she showed significant improvements in limb muscle strength, balance ability, swallowing, language function, and the ability to perform activities of daily living. However, when assessed using the Korean Wechsler Intelligence Scale for Children-IV, there was little improvement in cognitive function, particularly in working memory. While only a few cases have reported the progression of cognitive function using a standardized cognitive evaluation tool in patients with anti-N-methyl-D-aspartate receptor encephalitis, this present case report adds to the accumulation of evidence of neurocognitive deficits in these patients.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/71/bn-16-e12.PMC10404809.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brain & NeuroRehabilitation","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.12786/bn.2023.16.e12","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Anti-N-methyl-D-aspartate-receptor encephalitis is a complex autoimmune inflammatory neurological disorder that presents with epileptic seizures and rapid functional deterioration, including movement disorders and cognitive impairment, especially in young patients. Despite aggressive initial treatment with immune therapy, such as corticosteroids, intravenous immunoglobulin, and plasmapheresis, patients often need intensive rehabilitative therapies for their long-lasting deficits. We report a pediatric case of anti-N-methyl-D-aspartate receptor encephalitis in Korea that presented with symptoms of muscle weakness of the four extremities, dysarthria, dysphagia, and cognitive impairment in the acute phase. The patient underwent 4 weeks of comprehensive rehabilitative treatment, including physical therapy, occupational therapy, swallowing rehabilitation therapy, cognitive rehabilitation therapy, and speech therapy. At the follow-up evaluation after 4 weeks of treatment, she showed significant improvements in limb muscle strength, balance ability, swallowing, language function, and the ability to perform activities of daily living. However, when assessed using the Korean Wechsler Intelligence Scale for Children-IV, there was little improvement in cognitive function, particularly in working memory. While only a few cases have reported the progression of cognitive function using a standardized cognitive evaluation tool in patients with anti-N-methyl-D-aspartate receptor encephalitis, this present case report adds to the accumulation of evidence of neurocognitive deficits in these patients.
抗n -甲基- d -天冬氨酸受体脑炎是一种复杂的自身免疫性炎症性神经系统疾病,表现为癫痫发作和快速功能恶化,包括运动障碍和认知障碍,特别是在年轻患者中。尽管最初使用免疫疗法进行积极治疗,如皮质类固醇、静脉注射免疫球蛋白和血浆置换,但患者往往需要强化康复治疗来治疗其长期缺陷。我们报告了一例韩国的儿童抗n -甲基- d -天冬氨酸受体脑炎病例,急性期表现为四肢肌肉无力、构音障碍、吞咽困难和认知障碍。患者接受了4周的综合康复治疗,包括物理治疗、作业治疗、吞咽康复治疗、认知康复治疗、言语治疗。在治疗4周后的随访评估中,患者在肢体肌肉力量、平衡能力、吞咽、语言功能和日常生活活动能力方面均有显著改善。然而,当使用韩国韦氏儿童智力量表- iv进行评估时,他们的认知功能几乎没有改善,尤其是在工作记忆方面。虽然只有少数病例报告了使用标准化认知评估工具在抗n -甲基- d -天冬氨酸受体脑炎患者中认知功能的进展,但本病例报告增加了这些患者神经认知缺陷的证据积累。