Intravenous methylprednisolone versus therapeutic plasma exchange for treatment of anti-N-methyl-D-aspartate receptor antibody encephalitis: A retrospective review.

Abstract

INTRODUCTION:

Anti-N-methyl-d-aspartate (NMDA) receptor antibody encephalitis is an increasingly recognized form of autoimmune encephalitis. Conventional treatments include therapies such as corticosteroids, intravenous immunoglobulin (IVIg), and/or therapeutic plasma exchange (TPE). Although TPE is regularly used for treatment of anti-NMDA receptor antibody encephalitis, the American Society for Apheresis has given it a category III recommendation only. Earlier administered immunotherapies in tumor-negative patients may facilitate faster recoveries, but it remains unclear whether or not TPE is superior to steroids and/or IVIG.

METHODS:

We retrospectively evaluated 10 of 14 patients that received steroids and TPE with modified Rankin scores and subjectively assessed the point of largest sustained improvement in all 14 patients.

RESULTS:

In the patients that received both steroids and TPE at our institution during the same hospitalization (only 10 of 14 patients), 7/10 patients after TPE had improved with the modified Rankin score versus 3/10 patients after steroids. The average modified Rankin score improvement after steroids in this group was -0.1 as compared with 0.4 after TPE. Based on subjective chart review analysis during which all 14 patients were assessed, the largest sustained improvement occurred immediately following the third-fifth exchange in 9/14 patients, whereas only 2/14 patients appeared to have had significant benefit immediately following steroids.

CONCLUSIONS:

This is compelling preliminary data that suggests that corticosteroids may not be as effective compared to steroids followed by TPE. Given the importance of time-sensitive treatment, more formal studies may illuminate the ideal first-line treatment for anti-NMDA receptor antibody encephalitis.

• Authors: Allen D DeSena, Daniel K Noland, Karen Matevosyan, Kathryn King, Lauren Phillips, Sara S Qureshi, Benjamin M Greenberg, Donna Graves
• Journal: Journal of clinical apheresis (J Clin Apher) Vol. 30 Issue 4 Pg. 212-6 (Aug 2015) ISSN: 1098-1101 [Electronic] United States
• PMID: 25664728 (Publication Type: Journal Article)
• Copyright: © 2015 Wiley Periodicals, Inc.

Chemical References

• Adrenal Cortex Hormones
• Receptors, N-Methyl-D-Aspartate
• Steroids
• Methylprednisolone

Topics

• Adolescent
• Adrenal Cortex Hormones (administration & dosage)
• Adult
• Child
• Child, Preschool
• Encephalitis (drug therapy, immunology)
• Female
• Humans
• Immunotherapy (methods)
• Infant
• Infusions, Intravenous (methods)
• Male
• Methylprednisolone (administration & dosage)
• Middle Aged
• Plasma Exchange (methods)
• Receptors, N-Methyl-D-Aspartate (immunology)
• Retrospective Studies
• Steroids (therapeutic use)
• Time Factors
• Young Adult