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Early Functional Outcomes for Pediatric Patients Diagnosed with Anti–N-Methyl-D-Aspartate Receptor Encephalitis during Inpatient Rehabilitation

Howarth, Robyn A. PhD; Vova, Joshua MD; Blackwell, Laura S. PhD

American Journal of Physical Medicine & Rehabilitation: July 2019 - Volume 98 - Issue 7 - p 529–535
doi: 10.1097/PHM.0000000000001087
Original Research Articles: CME Article . 2019 Series . Number 7
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CME

Objective The aims of the current study were to characterize the demographic and clinical presentation of pediatric patients diagnosed with anti–N-methyl-D-aspartate receptor encephalitis who require inpatient rehabilitation, to examine early functional outcomes, and to investigate predictors of early recovery.

Design A retrospective chart review was conducted for 27 pediatric patients diagnosed with anti–N-methyl-D-aspartate receptor encephalitis who received intensive inpatient neurorehabilitation.

Results On average, patients were 10.6 yrs of age (range, 2–18 yrs) at the time of symptom onset. Average time to treatment from symptom onset was 27.2 days (range, 5–91 days). Patients displayed significant improvements between admission and discharge Functional Independence Measure for Children (WeeFIM) Developmental Functional Quotient (DFQ) scores across patients (P < 0.01). Mean Functional Independence Measure for Children Total Developmental Functional Quotient score at admission was 28.6 (range, 15.0–62.6) and at discharge was 54.3 (range, 14.2–91.9). Younger age at onset, seizures, and number of treatments received were associated with worse functional outcomes at discharge. Time to initiate treatment was not found to be associated with early functional outcomes.

Conclusion Pediatric patients diagnosed with anti–N-methyl-D-aspartate receptor encephalitis displayed significant functional gains during inpatient rehabilitation, despite persistent functional deficits at discharge, suggesting the need for ongoing monitoring and intervention.

To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives Upon completion of this article, the reader should be able to (1) Recognize the clinical presentation of anti–N-methyl-D-aspartate receptor encephalitis in pediatric patients, (2) Appreciate the role of rehabilitation in the care of the pediatric patient with anti–N-methyl-D-aspartate receptor encephalitis, and (3) Identify demographic and clinical variables that predict poor functional outcomes after rehabilitation in pediatric patients with anti–N-methyl-D-aspartate receptor encephalitis.

Level Advanced.

Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Departments of Neuropsychology (RAH, LSB) and Physical Medicine & Rehabilitation (JV), Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.

All correspondence should be addressed to: Robyn A. Howarth, PhD, Children's Healthcare of Atlanta, Department of Neuropsychology, 5461 Meridian Mark Rd, Suite 180, Atlanta, GA 30342.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Online date: October 31, 2018

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