Anti-NMDA receptor encephalitis is an autoimmune encephalitis with antibodies to NMDA receptor. What are typical pediatric clinical features?

• A. Psychiatric symptoms, behavioral changes, seizures, movement disorders, autonomic instability
• B. Gradual motor decline with ataxia
• C. Isolated ophthalmoplegia
• D. Progressive cognitive decline without seizures

Answer: (A)

Anti-NMDA receptor encephalitis in children commonly presents with a mix of neuropsychiatric and autonomic features that evolve over days to weeks. The immune attack on NMDA receptors often starts with abrupt behavioral changes, agitation, anxiety, or other psychiatric-like symptoms. As the illness progresses, seizures frequently occur, and movement disorders emerge, such as orofacial dyskinesias, chorea, or dystonia. Autonomic instability is another hallmark, with fluctuations in heart rate and blood pressure, fever, and sometimes respiratory difficulties requiring close monitoring. This combination of psychiatric symptoms, seizures, movement abnormalities, and autonomic dysfunction is the classic pattern seen in pediatric cases.

Other patterns like a gradual motor decline with ataxia, isolated ophthalmoplegia, or pure progressive cognitive decline without seizures don’t fit this syndrome as well, since they lack the characteristic acute neuropsychiatric onset with concurrent seizures and autonomic changes that define anti-NMDA receptor encephalitis in children.