Bickerstaff’s brainstem encephalitis in childhood: a literature overview

S. Marino, L. Marino, F. Greco, V. Venti, A. Fontana, T. Timpanaro, R. Taibi, E. Pustorino, M. Barbagallo, P. Pavone

Pediatric and Pediatric Emergency Department, University Hospital “Policlinico-San Marco, Catania, Italy. ppavone@unict.it

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• Neurology

OBJECTIVE: This is a review on clinical presentation, diagnosis, and treatment of reported cases of Bickerstaff brain encephalitis.

MATERIALS AND METHODS: Cases of pediatric Bickerstaff’s brainstem encephalitis collected from PubMed, Cochrane Library and Scopus Web of Science databases were reviewed. The inclusion criteria of the cases were based on age ≤ 18 years and the clinical characteristics of the disorder.

RESULTS: Twenty-seven articles on Bickerstaff’s brainstem encephalitis, including 236 children from a total of 42 from January 1990 to January 2020, were selected. The phenotype of the pediatric cases confirmed those described in the previously published articles. Almost half of the cases demonstrated the positivity of anti-GQ1b antibody titers, but the antibodies’ presence was not linked to longer healing time. However, it was found that individuals with neuroimaging changes needed a longer time to recovery. Overall, patients treated with any type of immunotherapy (intravenous immunoglobulins, steroid or plasmapheresis) demonstrated faster resolution of symptoms than supportive care.

CONCLUSIONS: Bickerstaff’s brainstem encephalitis is an uncommon disorder, the short-term and long-term prognoses depend on the clinical presentation of the disorder, co-morbidity, instrumental investigations, and precocity of treatment.

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