Steroid unresponsive anti-NMDA receptor encephalitis during pregnancy successfully treated with plasmapheresis

Shahani, Lokesh R

doi:10.1136/bcr-2014-208823

Cited by 25 publications

(16 citation statements)

References 11 publications

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“…A case series [10] suggested that early initiation of TPE or TPE followed by IVIG led to better outcomes in patients with anti-NMDA receptor encephalitis. Furthermore, fewer patients showed improvement following steroid treatment than the number of patients who improved immediately following TPE [11,12]. Despite the paucity of quality data on TPE in pediatric anti-NMDA receptor encephalitis, one review disclosed a trend toward better outcomes when TPE was administered early and when used in combination with steroids [13].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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The objective of the present study was to assess the efficacy of therapeutic plasma exchange (TPE) in patients with severe refractory anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis. Patients with severe anti-NMDA receptor encephalitis who showed no improvement after steroids and/or intravenous immunoglobulin treatment for at least 10 days were enrolled. All patients received immunotherapy and were divided into a TPE group and a non-TPE group according to treatment received. Each patient in the TPE group received at least 1 TPE course. NMDA receptor antibody titers in the cerebrospinal fluid (CSF) and plasma were evaluated within 1 week after the last TPE procedure. The clinical efficacy of treatment was evaluated after 1 month, 2 months, 3 months, 6 months, and 12 months. Forty patients were enrolled: 19 in the TPE group and 21 in the non-TPE group. Nineteen patients received TPE for a total of 118 procedures. NMDA receptor antibody titers in the CSF and/or plasma decreased or were negative after the last TPE procedure in 18 patients (94.7%). Compared with the non-TPE group, the TPE group exhibited greater clinical improvement after 1 month and 2 months following treatment (P < 0.05). After 3 months, 6 months, and 12 months, there were no significant differences in the outcomes between the TPE group and non-TPE group. The results suggest that TPE might rapidly improve the clinical manifestations in patients with severe refractory anti-NMDA receptor encephalitis, and we believe that TPE should be considered as a first-line treatment.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…9 Other authors proposed that the absence of serum NMDAR antibodies in the mother (e.g., only detected in CSF) decreases the risk of problems in the newborn. 5 Third trimester, n (%) 1 173 (14) Complications Death from septic shock, n (%) 0 (0) 2 (10) Obstetrical complications, n (%) 0 (0) 7 (33) Spontaneous miscarriage 0 (0) 2 (10) Uteroplacental insufficiency 0 (0) 1 Although all 3 reported infants with detectable NMDAR antibodies at birth had neurologic symptoms, in our series, the only newborn that tested positive was healthy. It is likely that the neurologic symptoms described in those infants resulted from a combination of factors that may include the potential pathogenic effects of the antibodies (usually transient) along with the side effects of sedatives, antiepileptics, and other drugs used during the pregnancy.…”

Section: Discussionmentioning

confidence: 68%

“…A review of the English literature identified 19 publications reporting 21 cases of anti-NMDAR encephalitis during pregnancy (table 1). [2][3][4][5][6][7][8][13][14][15][16][17][18][19][20][21][22][23][24] Median maternal age was 25 years (range, 18-36 years), and 18 (85.7%) patients required intensive care. A teratoma was found and removed in 10/21 (47.6%) patients.…”

Section: Review Of Previously Reported Patientsmentioning

confidence: 99%

Pregnancy outcomes in anti-NMDA receptor encephalitis

Joubert

García‐Serra

Planagumà

et al. 2020

Neurol Neuroimmunol Neuroinflamm

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ObjectiveTo report the effects of anti-NMDA receptor (NMDAR) encephalitis in pregnant patients and their babies.MethodsWe studied a retrospective cohort of patients who developed anti-NMDAR encephalitis during pregnancy or became pregnant while recovering from the encephalitis. In addition, we reviewed the English literature between 2010 and 2019 related to this topic.ResultsWe studied 11 patients; 6 developed anti-NMDAR encephalitis during pregnancy, and 5 became pregnant while recovering. There were no obstetrical complications, but 6 (55%) babies were premature. Ten newborns were healthy, and 1 (9%) developed transient respiratory distress. Nine infants had assessable follow-up (median 18 months; range, 7–96 months), and all showed normal development. We identified 21 cases in the English literature. Obstetrical complications occurred in 7 (33%) pregnancies. Two patients died of septic shock (1 baby successfully delivered), another 2 had miscarriages, and in 2, the pregnancy was terminated. Sixteen babies (76%) were delivered, 9 (56%) premature. At birth, 13/16 (81%) newborns were healthy, 2/16 (13%) had transient neurologic or respiratory symptoms, and 1 (6%) died of brain edema. Follow-up (median 12 months; range, 6–36 months) was reported for 8 children: 7 (88%) showed normal development and behavior, and 1 (13%) cortical dysplasia. Immunotherapy was used during pregnancy in 7 (64%) of our patients and 18 (86%) of the reported cases, including rituximab in 4 cases, without adverse effects.ConclusionsPatients who develop anti-NMDAR encephalitis during pregnancy or become pregnant during recovery often have obstetrical complications, but most of the newborns are healthy and appear to have normal development.

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“…Anti-NMDAR encephalitis associated with pregnancy has been increasingly reported (table). 2,[5][6][7][8][9][10] Symptom recovery after delivery, spontaneous improvement during pregnancy, or development during the postpartum period suggests the potential role of hormonal 2 or immunomodulatory effects of pregnancy. Most of the reported cases showed no sequela for mothers and newborns, except for 1 baby who presented with torticollis and strabismus.…”

Section: Discussionmentioning

confidence: 99%