Treatment Approaches in Pediatric Relapsing Autoimmune Encephalitis

IF 2 4区 医学 Q1 Medicine
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引用次数: 0

Abstract

Purpose of review

Autoimmune encephalitis (AE) is increasingly recognized as a treatable cause of encephalitis in children. While prior observational studies demonstrate improved motor outcomes with early immunotherapy, less is known about long-term management and treatment for relapsing disease. In this review, we present current treatment approaches to pediatric AE, in particular relapse risk and treatment for relapsing AE in children.

Recent findings

A recent meta-analysis of anti-NMDAR encephalitis demonstrated that disease onset in adolescence was associated with an increased odds of relapse whereas treatment with rituximab and IVIG for 6 months or longer were associated with a non-relapsing course. However, no specific pediatric sub-analyses were reported. A single-center study on adult and pediatric AE showed that rituximab use was associated with a reduction in time to relapse and recurring relapses although the data for the pediatric cohort did not achieve statistical significance.

Summary

The use of second-line immunotherapy during the initial attack may reduce the risk for relapsing disease in pediatric AE. Larger studies are needed to investigate relapse risk and treatment in both anti-NMDAR and non-NMDAR encephalitis in children.

小儿复发性自身免疫性脑炎的治疗方法
摘要 综述目的 越来越多的人认识到,自身免疫性脑炎(AE)是一种可治疗的儿童脑炎病因。先前的观察性研究表明,早期免疫治疗可改善运动能力,但对复发疾病的长期管理和治疗却知之甚少。在本综述中,我们将介绍目前治疗小儿脑炎的方法,尤其是复发风险和儿童复发性脑炎的治疗方法。 最近的研究结果 最近一项关于抗 NMDAR 脑炎的荟萃分析表明,青少年时期发病与复发几率增加有关,而使用利妥昔单抗和 IVIG 治疗 6 个月或更长时间与病程不复发有关。不过,没有具体的儿科子分析报告。一项针对成人和儿童 AE 的单中心研究显示,使用利妥昔单抗与复发时间缩短和复发次数减少有关,但儿童队列的数据未达到统计学意义。 总结 在初次发病时使用二线免疫疗法可能会降低小儿 AE 复发的风险。需要进行更大规模的研究,以调查儿童抗NMDAR和非NMDAR脑炎的复发风险和治疗方法。
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来源期刊
CiteScore
4.00
自引率
0.00%
发文量
40
审稿时长
6-12 weeks
期刊介绍: This journal aims to review the most important, recently published treatment option advances in the field of neurology. By presenting clear, insightful, balanced contributions by international experts, the journal intends to facilitate worldwide approaches to the treatment of neurologic conditions. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as epilepsy, headache, neurologic ophthalmology and otology, neuromuscular disorders, psychiatric manifestations of neurologic disease, and sleep disorders. Section Editors select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. We also provide commentaries from well-known neurologists, and an international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research.
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