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Effectiveness of Intravenous Immunoglobulin Therapy for Pediatric Viral Encephalitis

Annals of Child Neurology 2020년 28권 4호 p.145 ~ 155
변지은, 이경연,
소속 상세정보
변지은 ( Byun Ji-Eun ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Pediatrics
이경연 ( Lee Kyung-Yeon ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Pediatrics

Abstract


Purpose: Intravenous immunoglobulin (IVIg) is considered as a first-line therapy for autoimmune encephalitis. However, its effectiveness in viral encephalitis has yet to be evaluated. Therefore, we investigated the effectiveness of IVIg therapy for pediatric viral encephalitis.

Methods: We retrospectively reviewed the records of 35 pediatric patients who were hospitalized with confirmed or suspected viral encephalitis. Twenty patients (57.1%) were treated with IVIg in conjunction with conventional therapy (IVIg-treated group), and 15 patients (42.9%) were treated with conventional therapy (non-IVIg-treated group). We compared the clinical characteristics of the groups at admission and their clinical outcomes.

Results: Compared to the non-IVIg-treated group, the IVIg-treated group had more critical clinical features at admission, with a lower score on the pediatric Glasgow Coma Scale (mean±standard deviation, 9.1±2.3 vs. 10.8±2.7, P=0.025), longer fever duration (3.5±2.2 days vs. 1.8±1.1 days, P=0.022), and higher incidence of magnetic resonance imaging abnormalities (14/19 [73.7%] vs. 3/15 [20.0%], P=0.002). Nevertheless, the clinical outcomes of the IVIg-treated group were comparable to those of the non-IVIg-treated group in terms of mortality rate (1/20 [5.0%] vs. 0/15 [0%]), neurological deficits at discharge (2/20 [10.0%] vs. 1/15 [6.7%]), and occurrence of epilepsy (5/20 [25.0%] vs. 2/15 [13.3%]). Fourteen (70.0%) and 13 (85.7%) patients in the IVIg-treated and the non-IVIg-treated groups, respectively, achieved complete recovery without any neurological complications.

Conclusion: IVIg may be considered as a potential immunomodulating agent when treating critical pediatric viral encephalitis to improve neuropsychological outcomes.

키워드

Encephalitis, viral; Immunoglobulins, intravenous; Treatment outcome; Immunomodulation

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