Clinical analysis of 73 children with anti-N-methyl-D-aspartic receptor (NMDAR) encephalitis.

Background: Anti-N-methyl-D-aspartic receptor (NMDAR) encephalitis is a severe neurological condition often seen in pediatric patients. Early identification of clinical characteristics and prognostic risk factors is essential for optimizing diagnosis and treatment. This study aimed to systematically assess the clinical features and treatment outcomes of pediatric anti-NMDAR encephalitis and to identify independent prognostic risk factors for poor outcomes. Methods: This retrospective study included 73 pediatric patients with anti-NMDAR encephalitis. Demographic information, clinical presentation, diagnostic information [magnetic resonance imaging (MRI) and electroencephalography (EEG)], treatments received, and follow-up data were reviewed and analyzed. Based on modified Rankin Scale (mRS) scores at 2-month post-treatment follow-up, patients were stratified into favorable prognosis (mRS ≤2) and poor prognosis (mRS >2) groups. Comparative analyses of clinical parameters were performed using independent samples t-tests for continuous variables and the Pearson Chi-squared test for categorical variables. Statistically significant variables from univariate analyses were subsequently entered into a multivariate logistic regression model to identify independent prognostic factors. Results: Among the cohort, 51 patients (69.86%) achieved favorable outcomes, while 22 patients (30.14%) exhibited poor prognosis. Significant intergroup differences emerged in peak mRS scores (t=5.32, P<0.001), presence of abnormal MRI findings (χ2=8.15, P=0.004), and the presence of δ brush patterns on EEG (χ2=6.43, P=0.01). Multivariate logistic regression analysis identified two independent risk factors for a poor prognosis: elevated peak mRS scores [odds ratio (OR) =3.12, 95% confidence interval (CI): 1.45-6.72; P=0.004] and abnormal neuroimaging findings (OR =2.78, 95% CI: 1.18-6.54; P=0.02). Conclusions: Our findings demonstrate that elevated peak disease severity (as quantified by mRS) and structural brain abnormalities on MRI represent significant prognostic indicators in pediatric anti-NMDAR encephalitis. These parameters should be incorporated into clinical risk stratification models to guide therapeutic decision-making and prognostic counselling.