A Protocol for Evaluation and Treatment of Children with Autistic/Psychotic Regression

Objectives: We wish to describe 16 children with autistic or psychotic regression, suspected as part of autoimmune encephalitis, and to suggest a protocol for evaluation, treatment, and follow-up. Methods: This is a retrospective study describing children with suspected autoimmune encephalitis due to abrupt neuropsychiatric symptoms. Differentiating between an autistic regression and behavioral and communicative regression as part of autoimmune encephalitis is very challenging. We will present the clinical history, supportive diagnostic testing, including plasma and cerebrospinal fluid investigations, MRI, PET/SPECT, EEG, and genetic testing results, as well as treatment protocols used in our clinic, and the clinical impact of the medications. Preliminary results- twelve children received IVIG and steroids. Six of them had an improvement, with two children showing a remarkable recovery. One child did not benefit from this treatment, but was later diagnosed with SHANK3 mutation. Another child was diagnosed with a mass in the right caudate, and had a significant but temporary improvement. Four children received rituximab, but in non of them a significant improvement was noticed. Four children received tocilizumab, with a positive effect in one of them. Conclusion: Early diagnosis is extremely important in children with acute autistic or psychotic regression because treatment with immunomodulatory therapy may improve prognosis in cases of autoimmune encephalitis. Refining the protocol for evaluation, treatment, and follow-up based on clinical experience is highly needed. By sharing cases from our clinic we wish to expand our knowledge with hope to better diagnose and treat autoimmune encephalitis.