Table 5 Summary of clinical characteristic, clinical outcome, CSF findings, and treatment in published pediatric patients
Publication | Number of cases and ages | Clinical Characteristics | CSF pleocytosis range (cells/mcl) | Positive Antibodies | Treatment | Brain biopsy performed | Vasculitis noted on biopsy | Clinical outcome |
|---|---|---|---|---|---|---|---|---|
Pediatric Cases | ||||||||
Dubey et al. 2018 [31] | 10 children, 3–15 yo | Viral prodrome, ataxia, seizures meningoencephalitis, peripheral neuropathy, autonomic dysfunction | 12–159 | GFAP in serum and CSF | Steroids IVIG Plasmapheresis Rituximab | No | - | 5/10 – response to 1st line therapy 2/10—response to 2nd line therapy Outcome not indicated for 3 pts |
Francisco et al. 2019 [32] | One 6 yo child | Meningoencephalitis, abnormal eye movements, dysautonomia | 198, 385 | GFAP CSF Mycoplasma IgG, IgM | Steroids IVIG Rituximab | No | - | Normal neuro exam 17 months after initial symptoms, attention problems at school |
Handoko et al. 2019 [33] | One 12 yo child | Acute psychiatric decline 12 mo. after herpes simplex meningitis with migraines, memory deficits, impulsivity, hypersexuality, hallucinations | “Normal” | GFAP serum and CSF | Steroids IVIG Mycophenolate mofetil | No | - | Waxing and waning neuropsychiatric symptoms, cognitive difficulties in school |
Martin et al. 2018 [30] | One 13 yo child | Meningoencephalitis, photophobia, phonophobia, agitation, ataxia, hyperreflexia, dysautonomia | 204 | GFAP CSF NMDA-R CSF | Steroids IVIG Plasmapheresis | No | - | Ovarian teratoma identified and removed. Drastic improvement in neurologic symptoms after 2 months. Short term memory difficulty |
Oger et al. 2020 [34] | Two children, 10 and 16 yo | Meningoencephalitis, gait difficulty, nystagmus, dysautonomia, bladder dysfunction | 280–700 | GFAP serum and CSF | Steroids | No | - | Complete Recovery with normal brain MRI |
Rutatangwa et al. 2020 [35] | One 6 yo child | Meningoencephalitis | 198, 385 | GFAP CSF | Steroids IVIG Rituximab | No | - | Significant improvement with some residual symptoms at 17 mo. follow up |
Theroux et al. 2018 [36] | One 15 yo child | Meningoencephalitis, bilateral leg weakness, dizziness, catatonia, dysautonomia | 100 | GFAP CSF | IVIG Plasmapheresis Rituximab | No | - | Difficulty with memory and stamina, independent in all ADLS |
Trau and Gallentine 2018 [37] | One 10 yo child | Meningoencephalitis, weakness, ascending paralysis | “Elevated” | GFAP serum | Steroids IVIG Plasmapheresis | No | - | Full recovery within one year |