Peer-reviewed article
Nursing care of a pediatric patient with anti-NMDAR encephalitis complicated by secondary epilepsy: A case report.
Huang Q, Wang L ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a single clinical case report describing nursing care for one 13-year-old girl with anti-NMDAR autoimmune encephalitis and secondary epilepsy. The patient received immunotherapy and antiepileptic drugs and showed improvement in consciousness, cognition, muscle strength, and seizure control over three months. The report documents the clinical and nursing management of this rare condition in one individual patient.
Key points
- Patient presented with neuropsychiatric symptoms including hallucinations, mood disturbance, and seizures over a 2-month period
- Diagnosis confirmed by positive anti-NMDA receptor antibodies in cerebrospinal fluid and serum
- Treatment included first-line immunotherapy (corticosteroids, intravenous immunoglobulin), plasma exchange, and second-line rituximab
- Patient achieved improved consciousness, cognition, lower-limb strength (grade 4/5), and decreased seizure frequency
- At 3-month follow-up, patient returned to school with no reported relapse
Limitations
This is a single case report with no comparison group or control, so it cannot establish whether the observed improvements resulted from the treatment or would have occurred naturally. The report describes nursing and clinical management rather than evaluating the effectiveness of any specific intervention against a defined alternative.
Abstract
Rationale Autoimmune encephalitis in children often presents with neuropsychiatric symptoms and seizures and may progress to secondary epilepsy with prolonged functional impairment. Immunotherapy is the principal disease-modifying treatment, whereas comprehensive nursing care supports safety, complication prevention, rehabilitation, and continuity of care. Patient concerns A 13-year-old girl presented with a 2-month history of intermittent dizziness and poor appetite, followed by abnormal behavior, mood disturbance, visual hallucinations, and seizures. Diagnoses Based on characteristic neuropsychiatric manifestations, positive anti-N-methyl-d-aspartate receptor antibodies in cerebrospinal fluid and serum, and abnormal electroencephalographic findings, the patient was diagnosed with anti-NMDAR autoimmune encephalitis complicated by secondary epilepsy. Infectious encephalitis was initially considered. Interventions The patient received first-line immunotherapy including high-dose corticosteroids and intravenous immunoglobulin, followed by plasma exchange and second-line rituximab therapy. Antiepileptic drugs and anti-infective treatments were administered as indicated. Whole-process nursing care was implemented across acute, intensive care, rehabilitation, and post-discharge phases. Outcomes After multidisciplinary treatment and nursing support, the patient regained clear consciousness with improved cognition and communication. Lower-limb muscle strength improved to grade 4/5, seizure frequency markedly decreased, and independent ambulation was achieved. At 3-month follow-up, no relapse was reported and the patient had returned to school. Lessons This case highlights the importance of structured seizure safety management, strict infection prevention during immunotherapy, individualized rehabilitation guidance, and family-centered continuing care in pediatric anti-NMDAR autoimmune encephalitis complicated by secondary epilepsy.