Autoimmune Encephalitis in Children: Presentation, Diagnostic Difficulties, and Outcomes in Resource-Limited Settings

Purpose: Autoimmune encephalitis (AE) is an important noninfectious cause of pediatric encephalitis. Despite advances in the recognition of AE, many children are misdiagnosed during the early disease course, delaying treatment beyond the optimal therapeutic window. This study aimed to describe clinical characteristics, diagnostic challenges, treatment, and outcomes among pediatric patients with AE in Indonesia to inform management in resource-limited settings.Methods: This retrospective study included patients aged <18 years who were diagnosed with AE at Dr. Soetomo General Academic Hospital from January 2023 to October 2025. Diagnosis was established according to the diagnostic criteria for autoimmune encephalitis. Data on clinical characteristics, supporting examinations, treatment, and outcomes were reviewed. Functional outcomes were assessed using the modified Rankin Scale. Statistical analyses were performed using SPSS version 29.Results: The median patient age was 10 years, and seizures were the most common symptom, occurring in 13 of 14 patients. Six patients tested positive for anti–N-methyl-D-aspartate receptor antibodies. Treatment initiation was delayed, with a median time to treatment of 19 days. Among the 11 patients who completed follow-up, seven had good outcomes, defined as modified Rankin Scale scores of 0–2. However, three patients were lost to follow-up. The median hospital stay was 14 days (range, 7 to 37).Conclusion: Immunotherapy was associated with improved clinical outcomes despite delays in treatment initiation. Earlier disease recognition and improved access to diagnostic testing and immunotherapy are needed to improve the management and prognosis of pediatric patients with AE in similar healthcare settings.