Immunotherapy for Refractory Autoimmune Encephalitis

Abstract

Autoimmune encephalitis (AE) is an immune-mediated disease involving the central nervous system, usually caused by antigen-antibody reactions. With the advent of autoantibody-associated diseases, AE has become a hot research frontier in neuroimmunology. The first-line conventional treatments of autoimmune encephalitis consist of steroids, intravenous immunoglobulin (IVIG), plasma exchange (PLEX), and second-line therapy includes rituximab. Despite considerable research and expanding clinical experience, current treatments are still ineffective for a significant number of patients. Although there is no clear consensus, clinical trial evidence limited, and the level of evidence for some of the drugs based on single reports, third-line therapy is a viable alternative for refractory encephalitis patients. With the current rapid research progress, a breakthrough in the treatment of AE is critical. This article aims to review the third-line therapy for refractory AE

Immune Checkpoint Inhibitor Associated Autoimmune Encephalitis, Rare and Novel Topic of Neuroimmunology: A Case Report and Review of the Literature

“…Due to the presence of pathogenic autoantibodies, the treatment of ICI-associated AE includes withdrawal of ICI, IVIg, plasma exchange, and immunosuppressive therapies. As discussed above, most scholars support stopping ICI therapy and initiating immunosuppressive therapy [ 58 ]. According to the principle of toxicity management, only Grade 1 irAEs could continue ICI.…”

Perspective Chapter: Panic Disorder – A Real-World Case Due to Covid

“…Why this occurred is unclear because there were anecdotal reports from his treatment team that this intervention appeared to have reduced symptoms in other cases of AE that his physicians had encountered. On the other hand, there are researchers who report that available evidence shows that the combination of IVIG and steroid intervention continues to be ineffective for a significant number of patients suffering from AE [11]. The latter view certainly appeared to be valid in Jordan's case.…”

Psychiatrische Autoimmunenzephalitis – Diagnose und therapeutische Ansätze

“…Wahl ansprechenden Patienten mit Autoimmunenzephalitis stellt eine Herausforderung dar. In einer kürzlich erschienenen Übersichtsarbeit [26] wurden die derzeitigen Möglichkeiten einer Therapieeskalation umfassend diskutiert. Ein therapeutisches Ansprechen wurde bereits für einige Substanzen in Fallberichten und kleinen Kohorten gezeigt.…”

“…Dazu gehören Bortezomib, Tocilizumab, Ocrelizumab, Daratumumab, Tofacitinib, niedrig dosiertes Interleukin-2 und Rapamycin. Mechanismen dieser Substanzen umfassen die Modulation der B-Zellen mit B-Zell-Depletion und Reduktion der Autoantikörperproduktion, der T-Zell-Antworten und Zytokinrezeptoren [26]. Diese Therapien sind jedoch häufig mit starken Nebenwirkungen behaftet und sollten daher Einzelfällen als individueller Heilversuch nach individueller Aufklärung über den Nutzen und das Risiko vorbehalten sein.…”