Abstract Details

Title Systolic Blood Pressure Differentiates Pediatric NMDA Receptor Encephalitis in Acute-Onset Psychosis

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 021

Objective To identify early non-invasive biomarkers to differentiate isolated psychosis in NMDARE from other etiologies of acute-onset psychosis.

Background Pediatric NMDA receptor encephalitis (NMDARE) is an autoantibody-mediated neurological condition characterized by seizures, psychosis, movement disorder, and autonomic dysfunction. Definitive diagnosis requires the detection of anti-NMDAR antibodies in the CSF via an invasive lumbar puncture (LP). NMDARE symptoms are heterogeneous and may mimic other non-encephalitic disorders. Early diagnosis portends faster recovery with better outcomes, so non-encephalitic patients often undergo unnecessary LPs. Deciding to escalate workup is further complicated when patient presentation is limited to psychosis symptoms alone. Because early autonomic dysfunction is a cardinal feature of NMDARE, we investigated whether vital sign changes could be leveraged as a non-invasive biomarker to indicate appropriate escalation of workup in children presenting with only acute-onset psychosis.

Design/Methods This is a single-center, retrospective, case-control study comparing pediatric patients with psychosis-predominant NMDARE to non-NMDARE controls with psychosis between 2011-2023. We compared demographics, past medical history, presenting symptomatology, and early vital signs including blood pressure percentile standardized to age, sex, and height (BP%).

Results We compared 16 NMDARE patients who presented with isolated psychosis to 48 non-NMDARE controls who presented with psychosis. There was a greater proportion of females in the NMDARE group than non-NMDARE group (75.0% vs 39.6%, p<0.05), and males who presented with acute psychosis were significantly more likely to have non-NMDARE (87.9% vs 12.1% of males were diagnosed with non-NMDARE and NMDARE, respectively, p<0.05). Those with NMDARE had significantly higher absolute systolic BP% compared to the non-NMDARE group (96.3 +/- 1.1% vs 82.2 +/- 3.4%, p<0.001) while diastolic BP% and heart rate were not statistically different between the two groups.

Conclusions NMDARE is characterized by autonomic dysfunction reflected by early elevated systolic BP, providing a non-invasive biomarker to leverage in the screening process of acute-onset psychosis in children.

Authors/Disclosures
Alexander Sandweiss, MD, PhD PRESENTER	Dr. Sandweiss has nothing to disclose.
Naomi R. Kass	Ms. Kass has nothing to disclose.
Elizabeth Ledbetter	Miss Ledbetter has nothing to disclose.
Kimberly Imoh	Ms. Imoh has nothing to disclose.
Timothy Erickson (Texas A&M University)	Timothy Erickson has received research support from Centers for Disease Control and Prevention.
Jonathan Yarimi, MD (Memorial Healthcare)	Dr. Yarimi has nothing to disclose.
Jesse Levine, MD, PhD	Dr. Levine has nothing to disclose.
Anthony Zoghbi	No disclosure on file
Eyal Muscal	Eyal Muscal has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for sobi. An immediate family member of Eyal Muscal has stock in pfizer.
Kristy Murray (Baylor College of Medicine)	No disclosure on file
Nikita Shukla, MD (BCM)	The institution of Dr. Shukla has received research support from Roche.
Kristen Fisher, DO (Baylor College of Medicine)	Dr. Fisher has nothing to disclose.

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