Skip to main content

RETRACTED ARTICLE: Immune characteristics of children with autoimmune encephalitis and the correlation with a short-term prognosis

This article was retracted on 05 December 2023

This article has been updated

Abstract

Background

Autoimmune encephalitis (AE) is a type of encephalopathy mediated by an antigenic immune response in the central nervous system. Most research related to autoimmune encephalitis (AE) is focused on early diagnosis, treatment and prognosis analysis; there has been little research conducted on the characteristics of immune function, and the relationship between immune function and prognoses of patients with autoimmune encephalitis needs to be studied further.

Methods

A total of 33 children with autoimmune encephalitis were identified through the clinic database and inpatient consults at Tianjin Children’s Hospital from January 2013 to January 2021. Based on the one-year follow-up and the modified Rankin Scale (mRS) prognosis score, they were divided into a good prognosis group and a poor prognosis group. The immune function characteristics of the two groups of children with autoimmune encephalitis (AE) were compared using Spearman correlation to analyse the mRS score and immune function indicators (IgA, IgG, IgM, CD4, CD8, CD4/CD8), and binary logistic regression was used to analyse the independent risk factors of the prognoses in patients with autoimmune encephalitis (AE).

Results

The differences in abnormal mental disorders and limb dyskinesia, cognitive impairment, onset types, modified Rankin Scale (mRS) scores at admission, and immune function status during remission between the two groups were statistically significant (p < 0.05).

Conclusion

There is a close correlation between modified Rankin Scale (mRS) scores and the immune function index CD4/CD8 in children with autoimmune encephalitis (AE) when they are admitted to the hospital. A young age, disturbance of consciousness, limb dyskinesia, abnormal immune function in remission and anti-NMDAR encephalitis are risk factors for poor prognoses in children with autoimmune encephalitis (AE). Clinical treatment requires more attention.

Introduction

Autoimmune encephalitis (AE) is a type of encephalopathy mediated by an antigenic immune response in the central nervous system [1]. AE is the third most common cause of encephalitis; the first and second are infectious encephalitis and acute disseminated encephalomyelitis [2]. Most patients with AE have a cognitive impairment, acute or subacute seizures and other clinical manifestations [3]. The clinical presentations are complex and diverse. For example, magnetic resonance imaging (MRI) can reveal that some patients have no obvious abnormalities in radiological features [4]. Furthermore, AE has currently become a common cause of paediatric encephalopathy, and it usually occurs in younger females [5]. However, the diagnosis and treatment of children with AE is still an enormous challenge, and it may cause adverse effects on the recovery and prognoses of patients [6]. At present, the pathogenesis of AE is not clear. Some mathematicians propose that the occurrence of AE is related to immune function. Patients’ clinical brain injuries cause irreversible damage, and the prognoses are poor. Most research related to AE is focused on early diagnosis, treatment and prognosis analysis; there has been little research conducted on the characteristics of immune function, and the relationship between immune function and prognoses of patients with AE needs to be studied further [7]. Therefore, this study aims to analyse the clinical features, humoral immunity, cellular immunity and short-term prognosis of AE in children to provide more reference for clinical prognosis evaluation.

Methods

Patients

This was a retrospective case series of paediatric patients (< 18 years old), who met the national diagnostic criteria of AE, at the Tianjin Children’s Hospital (238 Longyan Road, Beichen District, Tianjin, China) between January 2013 and January 2021. Cases were identified through the clinic database and inpatient consults. Informed consent from the parents and assent from the patients were obtained. This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and approved by the ethics committee of Tianjin Children’s Hospital.

Inclusion criteria

The included patients fulfilled the diagnostic criteria for AE in paediatric patients [8,9,10]. A diagnosis of AE comprised a combination of clinical features, cerebrospinal fluid examination, neuroimaging and electroencephalogram examination; positive anti-neuronal antibody was the main basis for diagnosis.

  1. (1)

    Clinical features included the following: more acute onset, mental behaviour changes, abnormal posture or movements (mouth and face and limb movement abnormalities), seizures and autonomic nerve dysfunction.

  2. (2)

    Auxiliary examination consisted of the following:

  1. a.

    A cerebrospinal fluid examination showed a lymphocyte increase in cerebrospinal fluid and a positive oligoclonal zone.

  2. b.

    In the electroencephalography (EEG), epileptic discharge was not common, but slow waves were common, and sometimes rhythmic electrical activity unrelated to abnormal movement was seen.

  3. c.

    Head MRIs showed most patients were normal, but some patients had transient abnormal signals on FLAIR phases or MRIs.

  1. (3)

    Patients had one or more positive anti-neuronal antibodies in serum or cerebrospinal fluid.

Exclusion criteria

The exclusion criteria were as follows: encephalitis caused by other diseases; a history of glucocorticoids and other immunomodulators or immunosuppressants before observation; condition was complicated with blood, presence of tumours and allergic diseases; severe hepatic and renal insufficiency; failure to cooperate with treatment.

Procedures

Data recorded included demographic characteristics, clinical presentation, diagnostic workup that included laboratory studies, course and duration of treatment, response to treatment and short-term outcome.

Immune therapy is divided into first-line immunotherapy, second-line immunotherapy and long-term immunotherapy. First-line immunotherapy includes glucocorticoids, intravenous immunoglobulin and plasma exchange. Drugs used in second-line immunotherapy include rituximab and intravenous cyclophosphamide, etc., which are mainly given to patients who experience poor first-line immunotherapy results. Drugs used in long-term immunotherapy include mycophenolate mofetil and azathioprine, etc., which are mainly used in relapse cases, but can also be given to patients who experience poor first-line immunotherapy results and patients with negative anti-NMDAR encephalitis.

The antibody detection method is an indirect immunofluorescence assay. According to antigen substrates, it can be divided into two kinds: a cell-based assay (CBA) and a tissue-based assay (TBA). CBA and TBA transfected cells expressing neuron cell surface antigens use animal brain tissue sections as antigen substrates. CBA has high specificity and sensitivity. Matching cerebrospinal fluid and serum samples from patients should be fully tested. The initial dilution titres of cerebrospinal fluid and serum are 1:1 and 1:10, respectively.

The auxiliary examination was made as follows: the blood of the empty abdomen vein was 3 ml; the serum was separated by centrifugation for 30 min at 3000 r/minutes and the supernatant was taken. The serum IgA, IgG and IgM were measured by immunoturbidimetry. The levels of T lymphocyte subsets (CD3, CD4, CD8, CD4/CD8) in the peripheral blood were measured by flow cytometry. According to the modified Rankin Scale (mRS), patients were divided into two groups at the one-year follow-up: patients with an mRS score < 3 were placed in the good prognosis group, and patients with an mRS score ≥ 3 were placed in the poor prognosis group.

Statistical analysis

Data processing and descriptive statistical analysis were performed using the SPSS version 22.0 software. According to the normality test, the results were described as mean ± standard deviation \(\left(\overline{x}\pm s\right)\) or median (interquartile range). The comparison between the groups was completed using the Student’s unpaired t-test. Categorical data were described as n (%), and the comparison between the groups was performed using the χ2 test or exact probability test. The influencing factors of prognoses were analysed by a binary logistic regression model. Spearman correlation analysis was used to analyse the relationship between the mRS prognosis score and an immune function index. A p value of < 0.05 indicated statistical significance.

Results

Comparison of clinical data between the two groups

We identified 33 patients who presented features consistent with AE, of which 16 (48.5%) were male. These features were based on the proposed diagnostic criteria for AE in children and the mRS scores. There were 28 patients in the good prognosis group with a mean age of 7.7 ± 3.7 years; 15 (53.6%) were male. In the poor prognosis group, there were 5 patients with a mean age of 11.2 ± 5.8 years; 1 (20.0%) were male.

The clinical presentation of patients was different, with 16 patients (57.1%) suffering from limb dyskinesia. The poor prognosis group had a higher proportion of limb dyskinesia than the good prognosis group (100.0% vs 42.9%, p = 0.044). The most common presenting symptoms were mental seizures (63.6%). Eight patients had symptoms accompanied by cognitive impairments; all were in the poor prognosis group. In the good prognosis group, 50.0% of the patients had an infection onset, followed by fever, vomiting, headache and cough, which accounted for 42.9%, 14.3%, 25.0%, and 21.4%, respectively. In terms of the types of disease, 26 patients had an acute onset while 7 patients had a subacute onset. It seemed that the patients in the poor prognosis group suffered from a longer course of disease than the patients in the good prognosis group.

After the diagnosis, 16 patients received first-line immunotherapy. A total of 10 patients received second-line immunotherapy. There were 7 patients treated with long-term immunotherapy. Except for second-line immunotherapy, the good prognosis group tended to have a higher but comparable proportion of first-line immunological therapy than the poor prognosis group (p = 0.387) (Table 1).

Table 1 Comparison of demographic and clinical Features of AE patients between the two groups

Comparison of AE type and antibody type between the two groups

The are four types of AE among the included patients were anti-NMDAR encephalitis, Hashimoto encephalitis and anti-AMPA-R encephalitis and clinical diagnosis of AE. Most of the patients (51.5%) had anti-NMDAR encephalitis, and the proportion of patients with anti-NMDAR encephalitis in the good prognosis group was less than in the poor prognosis group (46.4% vs 80.0%). Then good prognosis group had 14 cases with clinical diagnosis of autoimmune encephalitis that was absent in the poor prognosis group. The type of antibody was distributed differently within the groups with a borderline p-value of 0.056.

Comparison of mRS scores at admission between the two groups

The mRS score of the good prognosis group at admission was significantly lower than that of the poor prognosis group (1.14 ± 0.65 vs. 3.20 ± 0.45), and the difference was statistically significant (p < 0.05) (Fig. 1).

Fig. 1
figure 1

Comparison of mRS scores at admission between the two groups

Comparison of immune function indices at admission between the two groups

There was no significant difference in CD8 between the two groups. IgA, IgG and IgM in the good prognosis group were significantly lower than in the poor prognosis group (p < 0.001, p = 0.001, p < 0.001), while CD4 and CD4/CD8 were significantly higher than in the poor prognosis group (p < 0.001, p = 0.001) (Table 2).

Table 2 Comparison of immune function indexes at admission between two groups

Correlation analysis between immune function indices and mRS scores at admission between the two groups

Spearman correlation analysis was used to analyse the relationship between the mRS score at admission and immune function indices with a statistical difference. The results showed that in 78 patients, the mRS score at admission was significantly negatively correlated with CD4/CD8 (r = − 0.775, p < 0.001). The mRS score at admission was negatively correlated with CD4/CD8 in the good prognosis group (r = − 0.834, p < 0.001) and in the poor prognosis group (r = − 0.470, p = 0.043). For different samples, there was no significant correlation between the mRS scores and IgA, IgG, IgM and CD4. Spearman correlation analysis showed that the mRS score at admission was significantly negatively correlated with CD4/CD8 (p < 0.05) but not significantly correlated with other immune function indices (Table 3).

Table 3 Spearman correlation analysis between immune function indexes and mRS scares at admission among two group

Analysis of influencing factors for poor prognoses in paediatric patients

Analysis of influencing factors for poor prognoses in children with acute disturbance syndrome consisted of independent variables: age, consciousness disorder (1 = yes, 2 = none), limb motor disorder (1 = yes, 2 = none), cognitive impairment (1 = yes, 2 = none), mRS score at admission, immune function state (1 = normal, 2 = abnormal) after admission and AE type (1 = anti-NMDAR encephalitis, 2 = anti-GABA-B encephalitis, 3 = anti-AMPA-R encephalitis). There was a correlation between the mRS score and immune function index CD4/CD8 in children with AE when they were admitted to the hospital. Multivariate analysis showed that mRS score at remission was risk factors for poor prognoses in children with AE (Table 4).

Table 4 Multivariate logistic regression analysis for prognosis at 1-year follow-up in children with AE

Discussion

Children in need of clinical treatment for viral encephalitis has been a common occurrence for quite some time [4, 11]. Clinical presentation has mainly been classified by type; types include mental symptoms, epileptic seizures, motor disorders, language disorders, sleep disorders, autonomic nervous dysfunction and ventilation disorders [12]. The duration of the disease could be several months or more, which is costly, and the lesions often involve the limbic system, mainly the cingulate gyrus, hippocampus and frontal lobe [13, 14]. Previously, it was diagnosed as sporadic encephalitis. However, in recent years, studies have found that the disease is closely associated with a variety of autoantibodies, which has been regarded as a common autoimmune disease. The involved part of the brain parenchyma went beyond the limbic system and was later called AE. It involved many parts of the central nervous system [15].

Compared with adult patients with AE, there were significant differences in clinical presentation, antibody levels, treatment and prognoses of children with AE [16]. The children with AE showed different types of clinical presentation, as mentioned above [12]. Infection and fever were mainly prodromal symptoms. As research suggests, neuroimaging, EEG, lumbar puncture and serologic testing is necessary for children with clinical presentations of AE [5]. In this study, more than 80% of the EEGs were abnormal; they showed unilateral or bilateral epileptic activity focus and focal/extensive slow waves. Cerebrospinal fluid examinations showed that about 60% of the children with AE had a mild increase of lymphocytes, but the total number of lymphocytes was usually in the range of 100 /ul and no more than 150 mg/dl. The protein content may increase slightly, but the sugar content still maintains a normal level. For patients with or without inflammatory changes in cerebrospinal fluid, 70–80% showed a high signal intensity, asymmetry and unilateral abnormal lesions on the FLAIR or T2 images, and other parts could have been involved. AE refers to a disease in which the immune system responds to the antigens and antibodies produced by central nervous system antigens, resulting in central nervous system damage. With the increasing understanding of AE, related reports are present from time to time. For children with suspected AE, serum and cerebrospinal fluid antibody tests, brain MRIs, EEG examinations and systemic tumour screenings should be carried out as soon as possible. Suitable treatment should be implemented immediately to obtain a good prognosis. For example, some studies reported that surgery was performed on children who were diagnosed with paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. A tonsillectomy was reported to resolve the neuropsychiatric symptoms in children with AE. However, the prognosis is still controversial, highlighting the need for further research in this area [17]. Our research showed that after hospitalisation, 75.64% (59/78) of the patients basically recovered and were discharged normally according to the one-year follow-up and the mRS score. This was consistent with 80% of the expert consensus [16].

The pathogenesis of AE is not clear. Previous studies have shown that AE is associated with viral infections, tumours or autoimmunity [18, 19]. Since the concept of ‘borderline encephalitis’ was put forward in 1968, researchers from home and abroad have found related autoantibodies, such as the Hu antibody and anti-glutamate dehydrogenase antibody. In addition, some studies pointed out that the occurrence of AE was also associated with antithyroid antibodies [20]. It is suggested that the pathogenesis of AE is closely related to autoimmune dysfunction. Therefore, this study reviewed the clinical data of 33 children with AE, according to the one-year follow-up mRS score (prognosis), to explore the relationship between humoral immune function, cellular immune function and the short-term prognoses of children with AE.

Humoral immunity is a specific immunity, mainly caused by the production of corresponding antibodies by B lymphocytes under the stimulation of antigens. When an antigen enters the body, B lymphocytes will be sensitised under its stimulation, accelerating the value added and differentiation, and producing corresponding antibodies; this is referred to as immunoglobulin. According to the composition and structure, immunoglobulins are divided into five categories: IgA, IgM, IgG, IgD and IgE. Among them, IgA, IgM and IgG levels can be used as important indicators to evaluate humoral immune function [21, 22]. T lymphocytes mainly mediate cellular immunity, and at the same time, can regulate humoral immunity. There are many CD molecules on the surface of T cells, such as CD3, CD4 and CD8, which are widely involved in the whole process of T cell recognition, activation, proliferation, apoptosis and elimination of allogeneic antigen [23]. The surface antigen of T lymphocytes is divided into the CD4 subgroup and the CD8 subgroup. CD4 and CD8 cells coordinate and restrict each other under normal physiological conditions, and the ratio of CD4/CD8 is in dynamic equilibrium. When the dynamic balance is broken, the ratio of CD4/CD8 is decreased, which indicates that the immune regulatory network is out of balance and the immune function is decreased. In a low immune state, the decrease of CD4 content and CD4/CD8 ratio can further stimulate B lymphocytes to secrete antibodies, form immune complexes and activate complements, which may cause a variety of diseases [24].

In this study, humoral immunity and cellular immune levels of the two groups of children with AE found that there were great differences in remission immune function. Abnormal immune status in the poor AE prognosis group (40.0%) tended to be lower than in the good AE (71.4%) but without significant difference. The IgA, IgG, IgM, CD4 and CD4/CD8 levels in patients with good prognoses were significantly better than in patients with poor prognoses. It was suggested that overall hyperthyroidism of humoral immunity in AE in patients with poor prognoses was more obvious than in patients with good prognoses. There was a significant negative correlation between mRS scores and CD4/CD8 levels at admission, which suggested that there was a close relationship between immune function and prognosis. In addition, this study analysed the factors affecting the prognoses in children with AE and found that a young age, disturbance of consciousness, limb movement disorders and abnormal immune function in remission stage were the risk factors for poor prognoses in children with AE [25,26,27]. Other risk factors were consistent with previous studies except for the younger age. However, there is no statistical data on the population and age of children with high incidence. In this study, a young age was the primary risk factor considered in the conclusion. The possible reasons for this are as follows: (1) AE accounted for about 10–20% of all encephalitis cases, and this study had a small sample size, resulting in inconsistent conclusions; (2) compared with older children, the immune function of young children is weaker, and the immune network is more likely to be unbalanced, which leads to a poor prognosis. Because of the small sample size, the varied response to therapy in our study could be explained with different autoimmune encephalitis antibodies, making it difficult to draw conclusions from each group.

Conclusion

There is a close relationship between immune function and the prognoses in children with AE. A higher mRS score in the remission stage was an independent risk factors for poor prognoses for children with AE.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Change history

References

  1. Rutatangwa A, Mittal N, Francisco C, Nash K, Waubant E. Autoimmune encephalitis in children: a case series at a tertiary care center. J Child Neurol. 2020;35(9):591–9. https://doi.org/10.1177/0883073820923834 Epub 2020 May 27. PMID: 32458722.

    Article  PubMed  Google Scholar 

  2. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, Cunningham R, Zuckerman M, Mutton KJ, Solomon T, Ward KN, Lunn MP, Irani SR, Vincent A, Brown DW, Crowcroft NS, UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010;10(12):835–44. https://doi.org/10.1016/S1473-3099(10)70222-X Epub 2010 Oct 15. Erratum in: Lancet Infect Dis. 2011 Feb;11(2):79. PMID: 20952256.

    Article  PubMed  Google Scholar 

  3. Aksamit AJ Jr. Treatment of viral encephalitis. Neurol Clin. 2021;39(1):197–207. https://doi.org/10.1016/j.ncl.2020.09.011 Epub 2020 Nov 7. PMID: 33223083.

    Article  PubMed  Google Scholar 

  4. Seniaray N, Verma R, Ranjan R, Belho E, Mahajan H. 18F-FDG PET/CT in initial diagnosis and treatment response evaluation of anti-NMDAr and anti-GAD dual antibody autoimmune encephalitis. Clin Nucl Med. 2021;46(1):e63–4. https://doi.org/10.1097/RLU.0000000000003379 PMID: 33181746.

    Article  PubMed  Google Scholar 

  5. Barbagallo M, Vitaliti G, Pavone P, Romano C, Lubrano R, Falsaperla R. Pediatric autoimmune encephalitis. J Pediatr Neurosci. 2017;12(2):130–4. https://doi.org/10.4103/jpn.JPN_185_16 PMID: 28904568; PMCID: PMC5588635.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Favier M, Joubert B, Picard G, Rogemond V, Thomas L, Rheims S, et al. Initial clinical presentation of young children with N-methyl-d-aspartate receptor encephalitis. Eur J Paediatr Neurol. 2018;22(3):404–11. https://doi.org/10.1016/j.ejpn.2017.12.014 Epub 2017 Dec 28. PMID: 29310866.

    Article  PubMed  Google Scholar 

  7. Morano A, Fanella M, Cerulli Irelli E, Barone FA, Fisco G, Orlando B, et al. Seizures in autoimmune encephalitis: findings from an EEG pooled analysis. Seizure. 2020;83:160–8. https://doi.org/10.1016/j.seizure.2020.10.019 Epub 2020 Oct 31. PMID: 33161244.

    Article  PubMed  Google Scholar 

  8. Endres D, Leypoldt F, Bechter K, Hasan A, Steiner J, Domschke K, et al. Autoimmune encephalitis as a differential diagnosis of schizophreniform psychosis: clinical symptomatology, pathophysiology, diagnostic approach, and therapeutic considerations. Eur Arch Psychiatry Clin Neurosci. 2020;270(7):803–18.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cellucci T, Van Mater H, Graus F, Muscal E, Gallentine W, Klein-Gitelman MS, et al. Clinical approach to the diagnosis of autoimmune encephalitis in the pediatric patient. Neurol Neuroimmunol Neuroinflamm. 2020;7(2):e663.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hongzhi G, Wang J. Diagnosis and treatment of autoimmune encephalitis in China. Chin J Neurol. 2017;50(02):91–8.

    Google Scholar 

  11. Oagawa S, Uchida Y, Kobayashi S, Takada K, Terada K, Matsukawa N. GABAB receptor autoimmune encephalitis presenting as transient epileptic amnesia. Rinsho Shinkeigaku. 2021;61(1):6–11. https://doi.org/10.5692/clinicalneurol.cn-001425 Japanese. Epub 2020 Dec 15. PMID: 33328416.

    Article  PubMed  Google Scholar 

  12. Ma J, Han W, Jiang L. Japanese encephalitis-induced anti-N-methyl-d-aspartate receptor encephalitis: a hospital-based prospective study. Brain and Development. 2020;42(2):179–84. https://doi.org/10.1016/j.braindev.2019.09.003 Epub 2019 Sep 25. PMID: 31563418.

    Article  PubMed  Google Scholar 

  13. Tanaka K, Kawamura M, Sakimura K, Kato N. Significance of autoantibodies in autoimmune encephalitis in relation to antigen localization: an outline of frequently reported autoantibodies with a non-systematic review. Int J Mol Sci. 2020;21(14):4941. https://doi.org/10.3390/ijms21144941 PMID: 32668637; PMCID: PMC7404295.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Ma X, Yin Q, Zeng Z, Wang C, Yang Y, Guo S. Thyroid function and autoimmune indications in patients with anti-N-methyl-D-aspartate receptor encephalitis. Neuroimmunomodulation. 2018;25(2):110–7. https://doi.org/10.1159/000492179 Epub 2018 Aug 29. PMID: 30157483.

    Article  CAS  PubMed  Google Scholar 

  15. Christie LJ, Loeffler AM, Honarmand S, Flood JM, Baxter R, Jacobson S, et al. Diagnostic challenges of central nervous system tuberculosis. Emerg Infect Dis. 2008;14(9):1473–5. https://doi.org/10.3201/eid1409.070264 PMID: 18760024; PMCID: PMC2603083.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gowda VK, Nagarajan B, Shivappa SK, Benakappa N. Seropositive anti-NMDAR mediated autoimmune encephalitis. Indian J Pediatr. 2020;87(11):961. https://doi.org/10.1007/s12098-020-03312-0 Epub 2020 May 13. PMID: 32405773.

    Article  PubMed  Google Scholar 

  17. Pavone P, Rapisarda V, Serra A, Nicita F, Spalice A, Parano E, et al. Pediatric autoimmune neuropsychiatric disorder associated with group a streptococcal infection: the role of surgical treatment. Int J Immunopathol Pharmacol. 2014;27(3):371–8. https://doi.org/10.1177/039463201402700307.

    Article  CAS  PubMed  Google Scholar 

  18. Frieling T, Kreysel C, Blank M, Müller D, Melchior I, Euler P, et al. Autoimmune encephalitis and gastrointestinal dysmotility: achalasia, gastroparesis, and slow transit constipation. Z Gastroenterol. 2020;58(10):975–81. https://doi.org/10.1055/a-1233-2190 English. Epub 2020 Oct 9. PMID: 33036051.

    Article  CAS  PubMed  Google Scholar 

  19. Elgendy M, Bhattacharjee S, Weatherby SJ, Lashley DJ. A rare cause of encephalitis with hypothermia and hyponatremia. Acta Neurol Belg. 2020;120(5):1245–6. https://doi.org/10.1007/s13760-020-01390-7 Epub 2020 Jun 5. PMID: 32504381.

    Article  PubMed  Google Scholar 

  20. Dutra LA, Abrantes F, Toso FF, Pedroso JL, Barsottini OGP, Hoftberger R. Autoimmune encephalitis: a review of diagnosis and treatment. Arq Neuropsiquiatr. 2018;76(1):41–9. https://doi.org/10.1590/0004-282X20170176 PMID: 29364393.

    Article  PubMed  Google Scholar 

  21. Platt MP, Bolding KA, Wayne CR, Chaudhry S, Cutforth T, Franks KM, et al. Th17 lymphocytes drive vascular and neuronal deficits in a mouse model of postinfectious autoimmune encephalitis. Proc Natl Acad Sci U S A. 2020;117(12):6708–16. https://doi.org/10.1073/pnas.1911097117 Epub 2020 Mar 11. PMID: 32161123; PMCID: PMC7104239.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Sharma M, Sood D, Chauhan NS, Negi P. Acute necrotizing encephalopathy of childhood. Neurol India. 2019;67(2):610–1. https://doi.org/10.4103/0028-3886.257990 PMID: 31085896.

    Article  PubMed  Google Scholar 

  23. Kobayashi Y, Kanazawa H, Hoshino A, Takamatsu R, Watanabe R, Hoshi K, et al. Acute necrotizing encephalopathy and a carnitine palmitoyltransferase 2 variant in an adult. J Clin Neurosci. 2019;61:264–6. https://doi.org/10.1016/j.jocn.2018.11.045 Epub 2018 Nov 22. PMID: 30470651.

    Article  PubMed  Google Scholar 

  24. Biswas A, Varman M, Gunturi A, Yoganathan S, Gibikote S. Teaching NeuroImages: acute necrotizing encephalopathy of childhood: neuroimaging findings. Neurology. 2018;90(2):e177–8. https://doi.org/10.1212/WNL.0000000000004800 PMID: 29311376.

    Article  PubMed  Google Scholar 

  25. Williams TA, Brunsdon RK, Burton KLO, Drevensek S, Brady C, Dale RC, et al. Neuropsychological outcomes of childhood acute necrotizing encephalopathy. Brain and Development. 2019;41(10):894–900. https://doi.org/10.1016/j.braindev.2019.07.007 Epub 2019 Jul 31. PMID: 31376945.

    Article  PubMed  Google Scholar 

  26. Lee YJ, Hwang SK, Kwon S. Acute necrotizing encephalopathy in children: a long way to go. J Korean Med Sci. 2019;34(19):e143. https://doi.org/10.3346/jkms.2019.34.e143 PMID: 31099193; PMCID: PMC6522889.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Abdelrahman HS, Safwat AM, Alsagheir MM. Acute necrotizing encephalopathy in an adult as a complication of H1N1 infection. BJR Case Rep. 2019;5(4):20190028. https://doi.org/10.1259/bjrcr.20190028 PMID: 31938561; PMCID: PMC6945259.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We are particularly grateful to all the people who have given us help on our article.

Funding

This study was supported by the Tianjin special project of science and technology for major disease prevention and control, China, Grant Number: [18ZXDBSY00170] from Chun-Quan Cai.

Author information

Authors and Affiliations

Authors

Contributions

J.Y., W.X. conceived of the study, and J.M. and C.Q. participated in its design and coordination and D. L. helped to draft the manuscript. All authors read and approved the final manuscript. Huang JY, Fan WX and Meng J were contributed equally to this study.

Corresponding author

Correspondence to Dong Li.

Ethics declarations

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of Tianjin Children’s Hospital. Guardians of all participants signed written informed consent.

Consent for publication

Not applicable.

Competing interests

All of the authors had no any personal, financial, commercial, or academic conflicts of interest separately.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article has been retracted. Please see the retraction notice for more detail: https://doi.org/10.1186/s13052-023-01566-w

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, JY., Fan, WX., Meng, J. et al. RETRACTED ARTICLE: Immune characteristics of children with autoimmune encephalitis and the correlation with a short-term prognosis. Ital J Pediatr 48, 94 (2022). https://doi.org/10.1186/s13052-022-01247-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13052-022-01247-0

Keywords