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cl:0-autoimmune-encephalitis [2020/06/09 07:13]
psychdb [Autoimmune Psychosis]
cl:0-autoimmune-encephalitis [2020/07/27 23:09] (current)
psychdb [Immunotherapy]
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 ===== Treatment ===== ===== Treatment =====
 ==== Immunotherapy ==== ==== Immunotherapy ====
-First-line therapy includes steroids, intravenous immune globulin (IVIG), plasma exchange (PLEX), or both IVIG and PLEX. Second-line therapy includes rituximab and cyclophosphamide. Rituximab is also increasingly being considered as a first-line therapy. Early immunotherapy improves outcomes.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC4516400/​|Byrne,​ S., Walsh, C., Hacohen, Y., Muscal, E., Jankovic, J., Stocco, A., ... & King, M. (2015). Earlier treatment of NMDAR antibody encephalitis in children results in a better outcome. Neurology-Neuroimmunology Neuroinflammation,​ 2(4), e130.]])] However, some patients may not respond to immunotherapy or may need intensive and prolonged therapies that require a tertiary or quaternary care setting.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​23290630/​|Titulaer,​ M. J., McCracken, L., Gabilondo, I., Armangué, T., Glaser, C., Iizuka, T., ... & Aguilar, E. (2013). Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis:​ an observational cohort study. The Lancet Neurology, 12(2), 157-165.]])]+First-line therapy includes ​intravenous ​steroids ​(methylprednisolone), intravenous immune globulin (IVIG), plasma exchange (PLEX), or both IVIG and PLEX. Second-line therapy includes rituximab and cyclophosphamide. Rituximab is also increasingly being considered as a first-line therapy.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC3613204/​|Paterson,​ R. W., Takada, L. T., & Geschwind, M. D. (2012). Diagnosis and treatment of rapidly progressive dementias. Neurology: Clinical Practice, 2(3), 187-200.]])] ​Early immunotherapy improves outcomes.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC4516400/​|Byrne,​ S., Walsh, C., Hacohen, Y., Muscal, E., Jankovic, J., Stocco, A., ... & King, M. (2015). Earlier treatment of NMDAR antibody encephalitis in children results in a better outcome. Neurology-Neuroimmunology Neuroinflammation,​ 2(4), e130.]])] However, some patients may not respond to immunotherapy or may need intensive and prolonged therapies that require a tertiary or quaternary care setting.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​23290630/​|Titulaer,​ M. J., McCracken, L., Gabilondo, I., Armangué, T., Glaser, C., Iizuka, T., ... & Aguilar, E. (2013). Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis:​ an observational cohort study. The Lancet Neurology, 12(2), 157-165.]])]