[Adolescents in the Pediatric Emergency Department: Detection of risk behavior and depression]. / Repérage des conduites à risque et des symptômes dépressifs chez les adolescents admis en service d'accueil des urgences.

OBJECTIVES: The main objective of this study was to estimate the prevalence of social and psychological problems, risk behaviors, and depression symptoms in a population of adolescents consulting in a Pediatric Emergency Department of a general hospital, and compare these according to the reasons for consulting. METHODS: Observational monocentric study, in the Pediatric Emergency Department of a general hospital in Britany, France, between January and September 2013, using a questionnaire dispensed to 12- to 18-year-old adolescents. The questions covered habits, school, symptoms, risk behaviors, and depression symptoms. Patients were classified into three groups based of the initial aim of the consultation: medical, traumatologic, and acute psychiatric. RESULTS: A total of 379 adolescents, median age: 15 years, were included. Adolescents from the "psychiatric" group resided significantly more often with only one of their parents or in a residential home; they were more often followed by an youth worker and/or a mental health professional such as a psychologist or a psychiatrist; consumed alcohol, cannabis, and/or tobacco more often; they complained more often of headache or abdominal and lumbar pain, dizziness, and sleep disorders; they consumed anxiolytic and hypnotic drugs more often; they ran away more often; and had signs of depression and/or suicidal ideation and behaviors. The prevalence of all these psychosocial and behavioral risks was also high in the two other groups. CONCLUSION: The Pediatric Emergency Department is a good place to detect adolescents with behavioral problems and/or depression symptoms, even if this is not the initial purpose of admission.

[N-methyl-D-aspartate receptor antibody encephalitis: value of immunomodulatory therapy]. / Encéphalite à anticorps anti-récepteurs N-méthyl-D-aspartate (NMDA-R) : place des immunomodulateurs.

INTRODUCTION: Anti-N-methyl-D-aspartate receptor (NMDA-R) encephalitis is little known to pediatricians and likely underdiagnosed. The child's vital and cognitive prognosis is at stake. The use of immunomodulatory drugs, such as rituximab has led to spectacular results, but many questions remain about its mode of action in this type of pathology. CASE REPORT: We report the case of a 6-year-old girl with no medical history, admitted for status epilepticus preceded by behavior symptoms and sleep disorders. Gradually, the child became bedridden, mute, and animated by predominantly orofacial dyskinesia. Examinations were normal (cerebrospinal fluid [CSF] analysis, brain MRI). The diagnosis was established by the presence of NMDA-R antibodies in the CSF. After exclusion of a tumor-associated syndrome, treatment was started initially by intravenous immunoglobulins, then by plasma exchange, and finally rituximab. The patient was cured with rituximab despite an unusually early recovery of the B-cell pool. DISCUSSION: Anti-N-methyl-D-aspartate receptor (NMDA-R) encephalitis is a severe but potentially reversible neurologic disorder only recently described, even in childhood. It may be reversible without sequelae if diagnosed and treated early. The use of immunomodulatory therapy, such as rituximab seemingly improves the outcome. Immunological monitoring is needed to better understand its mechanism of action in autoimmune diseases of the nervous system in childhood.