Efficacy of Therapeutic Plasma Exchange in Patients with Severe Refractory Anti-NMDA Receptor Encephalitis

Zhang, Yan; Liu, Gang; Jiang, Mengdi; Chen, Weibi; Su, Yingying

doi:10.1007/s13311-019-00725-4

Cited by 29 publications

(31 citation statements)

References 26 publications

(44 reference statements)

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“…In this study, there were no serious adverse events associated with the use of TPE or treatment-related deaths. There is overlap (20 patients) between our prior cohort 6 and the cohort in the current trial, and the constituent ratio of various types of adverse events was basically consistent.…”

Section: Discussionsupporting

confidence: 57%

“…3 Therapeutic plasma exchange (TPE) is one of the recommended treatments for AE because of its immune-mediated pathogenesis. [4][5][6][7] The aim of TPE is to remove putative disease mediators from the body, such as toxic macromolecules and pathogenic autoantibodies. 8 However, the use of TPE in the treatment of AE is still limited for various reasons, including plasma accessibility, cost, and other considerations, such as the lack of sufficient scientific evidence revealing the therapeutic mechanism of TPE.…”

Section: Introductionmentioning

confidence: 99%

“…Therapeutic plasma exchange (TPE) is one of the recommended treatments for AE because of its immune‐mediated pathogenesis 4–7 . The aim of TPE is to remove putative disease mediators from the body, such as toxic macromolecules and pathogenic autoantibodies 8 .…”

Section: Introductionmentioning

confidence: 99%

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Clinical efficacy of plasma exchange in patients with autoimmune encephalitis

Zhang

Huang

Chen

et al. 2021

Ann Clin Transl Neurol

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Objective To determine the clinical and antibody response after therapeutic plasma exchange (TPE) in patients with severe refractory antibody‐associated autoimmune encephalitis (AE). Methods This single‐center prospective cohort included all patients consecutively admitted to our hospital because of severe refractory AE over the period from July 2014 to June 2019. All patients received immunotherapy (steroids, intravenous immunoglobulin (IVIG), and/or TPE). The primary outcome was evaluated at 1‐ and 2‐month postenrollment, and the long‐term outcome was followed up at 6 and 12 months. AE antibody titers in the cerebrospinal fluid and plasma were evaluated before and after TPE/IVIG. Results This study enrolled 57 patients with severe refractory AE, including anti‐NMDA receptor encephalitis (n = 51), anti‐GABAb receptor encephalitis (n = 3), anti‐LGI 1 encephalitis (n = 2), and anti‐AMPA receptor encephalitis (n = 1). Of all 57 patients, 33 patients received TPE for a total of 193 procedures, and 24 patients with contraindications or refusal of TPE were in the non‐TPE group. Compared with the non‐TPE group, the TPE group exhibited greater clinical improvement: 21 (37%) versus 8 (14%) after 1 month (P = 0.03) and 31 (54%) versus 16 (28%) after 2 months (P = 0.01), respectively. Complications and adverse events associated with TPE occurred in 91 procedures (47%) without serious adverse events associated with the use of TPE. Interpretation TPE might be an effective rescue therapy associated with rapid functional improvement in patients with severe steroid/IVIG refractory antibody‐associated AE from this nonrandomized control trial.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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Clinical efficacy of plasma exchange in patients with autoimmune encephalitis

Zhang

Huang

Chen

et al. 2021

Ann Clin Transl Neurol

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“…Early diagnosis and treatment also confer a favorable prognosis. In patients not responding to first-line therapy, early initiation of therapeutic plasma exchange has been shown to improve clinical outcomes [13].…”

Section: Discussionmentioning

confidence: 99%

Not Your Average Seizure: A Case of N-Methyl-D-Aspartate Receptor Encephalitis and Review of Literature

Alkayali

Bell

Bass

et al. 2020

Cureus

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Encephalitis is an inflammatory process of the brain that is most commonly related to infectious etiology; nonetheless, autoimmune encephalitis has been an increasingly identified entity that can cause it as well and should be considered. N-methyl-D-aspartate (NMDA) receptor encephalitis is a recently identified process but remains less recognized than autoimmune encephalitis. We report a case of an 18-year old female who initially presented with seizures and later developed behavioral symptoms of agitation, crying, screaming, and emotional lability. Ultimately, she was found to have NMDA receptor encephalitis related to ovarian paraneoplastic teratoma. The patient was treated with anti-epileptics and intravenous immunoglobulin and underwent oophorectomy that lead to her recovery. This case highlights the importance of early recognition of NMDA receptor encephalitis to facilitate appropriate investigations and management.

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“…On the other hand, there are recent data supporting the use of plasmapheresis to improve the patient clinical status. [ 18 , 19 ] DeSena et al [ 20 ] compare the use of plasmapheresis alone versus before intravenous corticoids in the treatment of anti-NMDAR receptor encephalitis, with better results in the last case.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of anti-NMDA receptor encephalitis with early teratoma removal and plasmapheresis

et al. 2018

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RationaleThis report describes a Successful treatment of anti-NMDA receptor encephalitis with early teratoma removal and plasmapheresis.Patient ConcernsWe present a 31-year-old Caucasian nulliparous patient who was admitted as an emergency with general illness status accompanied by holocranial cephalalgia and fever.DiagnosesThe previous symptoms were followed by disorientation, persecutory delusion, incoherent language, and tonic-clonic seizure.InterventionsThe patient was admitted in the intensive care unit (ICU) with Glasgow score 7.OutcomesMost of complementary exams (brain CT, brain MRI, blood analysis, PCR for virus on CSF) were normal except CSF leucocytosis and hyperproteinorrhachia. An abdominopelvic ultrasound revealed a 5-cm solid-cystic tumor in the left adnexal region, suggestive of teratoma. At that stage, the possibility of autoimmune encephalitis was considered, and confirmed later.LessonsThis disease can only be successfully treated with fast surgical intervention and an early implementation of immunosuppressive therapies. The optimal timing of initiation and duration of therapeutic plasma exchange necessary to achieve good outcomes in patients with NMDAR remains unknown. This case report intends to increase awareness about the importance of early surgical treatment and early implementation of this potentially life-saving therapy and of continuing the treatment until complete remission of symptoms.

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Efficacy of Therapeutic Plasma Exchange in Patients with Severe Refractory Anti-NMDA Receptor Encephalitis

Cited by 29 publications

References 26 publications

Clinical efficacy of plasma exchange in patients with autoimmune encephalitis

Clinical efficacy of plasma exchange in patients with autoimmune encephalitis

Not Your Average Seizure: A Case of N-Methyl-D-Aspartate Receptor Encephalitis and Review of Literature

Successful treatment of anti-NMDA receptor encephalitis with early teratoma removal and plasmapheresis

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