Predictive value of persistent cerebrospinal fluid antibodies at 12 months for long-term clinical outcomes in pediatric anti-NMDAR encephalitis: a retrospective cohort study
- 1Department of Pediatrics, West China Second University Hospital, Sichuan University , , ,
Abstract
Background and objective: Persistent cerebrospinal fluid (CSF) antibodies against the N-methyl-D-aspartate receptor (NMDAR) are common in children recovering from anti-NMDAR encephalitis, but their association with long-term clinical outcomes remains unclear. This study aimed to assess whether persistent CSF NMDAR antibodies at 12 months after diagnosis predict long-term clinical outcomes.
Methods: In this retrospective observational cohort study, we included patients diagnosed with pediatric anti-NMDAR encephalitis between November 2012 and January 2026. Participants were stratified into two groups according to their CSF NMDAR antibody status at the 12-month follow-up. Clinical characteristics were compared between the groups, and long-term seizure-free rates were assessed using Kaplan–Meier survival analysis.
Results: Among 162 initially identified patients, 41 (25.3%) met the inclusion criteria (mean age 8.7 ± 4.2 years; 78.0% female). At 12 months, CSF NMDAR antibodies remained detectable in 68.3% (28/41) of patients. Although the antibody-persistent group showed a trend toward a higher relapse rate than the antibody-negative group (42.9% vs. 0%), this difference did not reach statistical significance ( P = 0.053). In contrast, the antibody-persistent group required significantly more frequent first-line (57.1% vs. 7.7%, P = 0.003) and second-line (39.3% vs. 0%, P = 0.024) immunotherapy.
Survival analysis revealed no statistically significant difference in seizure-free rates between the two groups during long-term follow-up (median 26 months; log-rank P = 0.601).
Conclusion: In pediatric anti-NMDAR encephalitis, persistent CSF NMDAR antibodies at 12 months serve as a marker of incomplete remission and are associated with a trend toward a higher relapse rate and a significantly greater need for intensified immunotherapy, and may help identify patients who would benefit from more intensive immunomodulatory therapy.
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BibTeX
@article{yang2026predictive,
title = {{Predictive value of persistent cerebrospinal fluid antibodies at 12 months for long-term clinical outcomes in pediatric anti-NMDAR encephalitis: a retrospective cohort study}},
author = {Hua Yang and Ruling Zhang and Jie Yang and Jingui Zhao and Xiaoling Zhong and Rong Luo},
journal = {Frontiers in immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1938331},
url = {https://europepmc.org/article/PMC/PMC13668519},
note = {CC BY},
}
RIS
TY - JOUR
TI - Predictive value of persistent cerebrospinal fluid antibodies at 12 months for long-term clinical outcomes in pediatric anti-NMDAR encephalitis: a retrospective cohort study
AU - Hua Yang
AU - Ruling Zhang
AU - Jie Yang
AU - Jingui Zhao
AU - Xiaoling Zhong
AU - Rong Luo
PY - 2026
DA - 2026/10/01
JO - Frontiers in immunology
DO - 10.3389/fimmu.2026.1938331
UR - https://europepmc.org/article/PMC/PMC13668519
AB - Background and objective: Persistent cerebrospinal fluid (CSF) antibodies against the N-methyl-D-aspartate receptor (NMDAR) are common in children recovering from anti-NMDAR encephalitis, but their association with long-term clinical outcomes remains unclear. This study aimed to assess whether persistent CSF NMDAR antibodies at 12 months after diagnosis predict long-term clinical outcomes. Methods: In this retrospective observational cohort study, we included patients diagnosed with pediatric anti-NMDAR encephalitis between November 2012 and January 2026. Participants were stratified into two groups according to their CSF NMDAR antibody status at the 12-month follow-up. Clinical characteristics were compared between the groups, and long-term seizure-free rates were assessed using Kaplan–Meier survival analysis. Results: Among 162 initially identified patients, 41 (25.3%) met the inclusion criteria (mean age 8.7 ± 4.2 years; 78.0% female). At 12 months, CSF NMDAR antibodies remained detectable in 68.3% (28/41) of patients. Although the antibody-persistent group showed a trend toward a higher relapse rate than the antibody-negative group (42.9% vs. 0%), this difference did not reach statistical significance ( P = 0.053). In contrast, the antibody-persistent group required significantly more frequent first-line (57.1% vs. 7.7%, P = 0.003) and second-line (39.3% vs. 0%, P = 0.024) immunotherapy. Survival analysis revealed no statistically significant difference in seizure-free rates between the two groups during long-term follow-up (median 26 months; log-rank P = 0.601). Conclusion: In pediatric anti-NMDAR encephalitis, persistent CSF NMDAR antibodies at 12 months serve as a marker of incomplete remission and are associated with a trend toward a higher relapse rate and a significantly greater need for intensified immunotherapy, and may help identify patients who would benefit from more intensive immunomodulatory therapy.
SN - 1664-3224
ER -