Nursing care of a pediatric patient with anti-NMDAR encephalitis complicated by secondary epilepsy
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.