Journal of Neurology

, Volume 265, Issue 1, pp 141–150 | Cite as

Pediatric Bickerstaff brainstem encephalitis: a systematic review of literature and case series

  • Jonathan Douglas Santoro
  • Daniel V. Lazzareschi
  • Cynthia Jane Campen
  • Keith P. Van Haren
Original Communication



To characterize the phenotype of pediatric Bickerstaff’s brainstem encephalitis (BBE) and evaluate prognostic features in the clinical course, diagnostic studies, and treatment exposures.


We systematically reviewed PubMed, Web of Science, and SCOPUS databases as well as medical records at the Lucile Packard Children’s Hospital to identify cases of pediatric BBE. Inclusion required all of the following criteria: age ≤ 20 years, presence of somnolence or alterations in mental status at the time of presentation or developed within 7 days of presentation, ataxia, and ophthalmoplegia.


We reviewed 682 manuscripts, identifying a total of 47 pediatric BBE cases. We also describe five previously unreported cases. The phenotype of these pediatric patients was similar to previously published literature. Sixty-eight percent of patients demonstrated positive anti-GQ1b antibody titers, yet the presence of these antibodies was not associated with longer times to recovery. Patients with neuroimaging abnormalities featured a longer median time to recovery, but this was not statistically significant (p = 0.124). Overall, patients treated with any form of immunotherapy (intravenous immunoglobulin, steroids, or plasmapheresis) demonstrated shorter median time to resolution of symptoms compared to supportive therapy, although this trend was not statistically significant (p = 0.277). Post-hoc t tests revealed a trend towards use of immunotherapy against supportive care alone (p = 0.174).


Our study identified clinical, radiologic, and treatment features that may hold prognostic value for children with BBE. The role of immunotherapy remains under investigation but may prove of utility with further, randomized controlled studies in this rare disease.


Pediatric Bickerstaff Brainstem Encaphalitis Immunotherapy 


Compliance with ethical standards

Conflicts of interest

All authors declared that they have no potential conflict of interest.

Ethical standards

For this type of study formal consent is not required.

Supplementary material

415_2017_8684_MOESM1_ESM.docx (124 kb)
Supplementary material 1 (DOCX 124 kb)
415_2017_8684_MOESM2_ESM.xlsx (51 kb)
Supplementary material 2 (XLSX 51 kb)
415_2017_8684_MOESM3_ESM.docx (94 kb)
Supplementary material 3 (DOCX 94 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Jonathan Douglas Santoro
    • 1
  • Daniel V. Lazzareschi
    • 2
  • Cynthia Jane Campen
    • 1
  • Keith P. Van Haren
    • 1
  1. 1.Division of Child NeurologyLucile Packard Children’s Hospital at StanfordPalo AltoUSA
  2. 2.Stanford University School of MedicinePalo AltoUSA

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