Children of all ages can have autoimmune diseases that affect the nervous system. Autoimmune diseases, including autoimmune encephalitis, can occur following an infection. They also can be related to a systemic autoimmune disease or a dysfunctional immune system, or no clear health issue.

Michael L. Sweeney, M.D., with Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine, completed his fellowship training in autoimmune neurology at the University of Utah, Salt Lake City. He is a part of the Autoimmune Encephalitis Alliance, a network of physicians dedicated to treating this disease.

Autoimmune Encephalitis Symptoms

Encephalitis is a disease that causes inflammation in the brain. Depending on the parts of the brain affected, symptoms can vary widely. Symptoms may include:

• Seizures
• Behavior or personality changes
• Abnormal movements
• Difficulty maintaining balance
• Trouble thinking or speaking
• Weakness
• Numbness
• Difficulty sleeping

There are several different types of encephalitis. When encephalitis occurs without a clear reason, it is called autoimmune encephalitis. Postinfectious encephalitis occurs after an infection. If encephalitis occurs with a tumor or cancer, it is called paraneoplastic encephalitis.

Anti-NMDA receptor encephalitis is the most common form of autoimmune encephalitis in children. It is caused by the presence of antibodies in a specific part of the nerve cells in the brain, called NMDA receptors. In children, this form of encephalitis can be associated with a tumor called an ovarian teratoma, but it is very rare.

Autoimmune Encephalitis Diagnosis

Diagnosing autoimmune encephalitis can be challenging. Our team’s first step is to do a thorough medical workup of your child. We will document his or her complete medical history and perform tests, including a neurological examination, magnetic resonance imaging of the brain (MRI), electroencephalography (EEG) and spinal fluid analysis.

Our team typically will do blood testing to evaluate your child for signs of inflammation and autoimmune disorders. We also may test for specific antibodies in the blood and spinal fluid, which can be helpful in making a diagnosis. The presence of a specific antibody is not necessary to make a diagnosis. We also may screen for an underlying tumor, which typically involves whole-body imaging.

Autoimmune Encephalitis Treatment

Treatment in the hospital is aimed at reducing the amount of inflammation within your child’s brain. Our team may use high doses of steroids, intravenous immunoglobulin and plasmapheresis. If needed, your child also may receive additional immunotherapies, such as rituximab or cyclophosphamide.

Our team may use medications to treat symptoms caused by encephalitis. If your child has seizures, we may prescribe antiepileptic medications. For mood changes, we may prescribe antipsychotic and antidepressant medications.

Long-term follow-up care with our team is important to address possible consequences of encephalitis, such as seizures, mood and personality changes, and learning difficulties.

Why Norton Children’s Neuroscience Institute?

• The Norton Children’s Hospital Comprehensive Epilepsy Center is a Level 4 epilepsy center, the highest rating available from the National Association of Epilepsy Centers. Norton Children’s Hospital has held this designation since 2013.
• We are the first in Kentucky and among the first in the nation to use neurostimulation in a pediatric patient.
• Regional neurology care is available for children across Kentucky and Southern Indiana. We travel to clinics in Bowling Green, Campbellsville, Corbin, Elizabethtown, Frankfort, Owensboro and Paducah, Kentucky; and Evansville, Indiana. We also perform a number of telemedicine visits each week.
• The specialists with Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine, use state-of-the-art technology to treat epilepsy, uncontrollable seizures and deep brain tumors in children who, in the past, would not be candidates for surgery, including:
  • Visualase: Technology that allows neurosurgeons to perform MRI-guided laser ablation surgery. Fewer than two dozen pediatric hospitals in the U.S. offer this technology.
  • Surgical Theater: Virtual reality technology that creates an immersive 3D view of a patient’s brain, allowing neurosurgeons, the patient and family to see inside the skull and brain to get a greater understanding of the condition and impact of potential procedures. Norton Children’s Hospital is the first hospital in the region to use this technology.
• We offer dedicated multidisciplinary clinics for brain tumors, traumatic brain injuries, spina bifida, craniofacial injuries and disorders, epilepsy, muscular dystrophy, spasticity, headache/migraine, autism and neurocutaneous disorders.
• Our multidisciplinary craniofacial program was the first established in the Midwest.
• We offer a neurogenetics clinic to evaluate and treat children with neurogenetic syndromes.
• We have a neuropsychology program that specializes in the evaluation of children and teens with a variety of neurological, neurodevelopmental and medical conditions, including brain tumors and epilepsy.
• Outpatient neurology facilities in downtown Louisville are equipped with in-office electroencephalography (EEG) capabilities and laboratory services in the same building, creating a streamlined, family-centered environment.
• We offer the region’s first clinic to treat children with immune-mediated neurological disorders.