Intrathecal Rituximab as a Rescue Therapy in Refractory Pure CSF Positive, Non-Teratomatous Type Anti-NMDAR Encephalitis

NMDAR antibody encephalitis is the most common autoimmune encephalitis characterized by a myriad of neuropsychiatric symptoms. It predominantly affects females and is associated with ovarian teratoma (58%). Nineteen percent do not respond to treatment and are left with serious neurological deficits....

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Bibliographic Details
Published in:Annals of the Indian Academy of Neurology 2022-09, Vol.25 (5), p.925-927
Main Authors: Krishnan, Parameswaran, Thomas, Kurian
Format: Article
Language:English
Subjects:
anti nmda receptor encephalitis
Case Report
Cerebrospinal fluid
Demographic aspects
Diagnosis
Drug therapy
Encephalitis
Glutamic acid receptors
Health aspects
Immunotherapy
intrathecal injection
Monoclonal antibodies
N-Methyl-D-aspartic acid receptors
Neurological diseases
non-paraneoplastic anti-nmdar encephalitis
Rituximab
Teenagers
Teratoma
Youth
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Summary:NMDAR antibody encephalitis is the most common autoimmune encephalitis characterized by a myriad of neuropsychiatric symptoms. It predominantly affects females and is associated with ovarian teratoma (58%). Nineteen percent do not respond to treatment and are left with serious neurological deficits. A subset of NMDAR encephalitis with antibody positivity in CSF alone without ovarian teratoma is often found to be refractory to treatment. We name them Pure CSF positive, non-teratomatous type anti-NMDAR encephalitis. We report two such cases who responded to intrathecal rituximab, to highlight a novel treatment as a rescue therapy to prevent long-term disability and improve clinical outcomes.
ISSN:0972-2327
1998-3549
DOI:10.4103/aian.aian_134_22