Rituximab for Autoimmune Encephalitis with Epilepsy
Intractable epilepsy remains a significant medical challenge, resulting in recurrent and prolonged intensive care unit (ICU) admissions. Autoimmune encephalitis is emerging as a treatable cause of intractable epilepsy. It is characterized by antibodies against cerebral antigens, such as potassium ch...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2020/5843089 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832553469146300416 |
|---|---|
| author | Mohankumar Kurukumbi Rahul H. Dave Jose Castillo Tulsi Shah Joanne Lau |
| author_facet | Mohankumar Kurukumbi Rahul H. Dave Jose Castillo Tulsi Shah Joanne Lau |
| author_sort | Mohankumar Kurukumbi |
| collection | DOAJ |
| description | Intractable epilepsy remains a significant medical challenge, resulting in recurrent and prolonged intensive care unit (ICU) admissions. Autoimmune encephalitis is emerging as a treatable cause of intractable epilepsy. It is characterized by antibodies against cerebral antigens, such as potassium channels such as leucine-rich, glioma inactivated 1 (LGI1) and contactin-associated protein 2 (CASPR2), calcium channels such as the voltage-gated calcium channel (VGCC), or neurotransmitter receptors such as the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), gamma aminobutyric acid receptor (GABAR), and N-methyl-D-aspartate receptor (NMDAR). Diagnosis requires a syndrome consistent with an antibody identified in serum or cerebrospinal fluid (CSF) using methods that minimize risk of false-positives. Although there is no officially approved therapy for these disorders, typical approaches involve chronic high-dose steroids, intravenous immunoglobulin (IVIG), or plasma exchange. Rituximab is effective for antibody-associated disorders such as lupus, myasthenia gravis, and neuromyelitis optica. Here, we present three patients who were admitted with recalcitrant status epilepticus and demonstrated serum antibodies against NMDAR, LGI1, or VGCC using a cell-based assay. All patients demonstrated complete, long-term epilepsy control and improvement in symptoms with rituximab. |
| format | Article |
| id | doaj-art-640415da24f84788ad13280618d03017 |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-640415da24f84788ad13280618d030172025-02-03T05:53:53ZengWileyCase Reports in Neurological Medicine2090-66682090-66762020-01-01202010.1155/2020/58430895843089Rituximab for Autoimmune Encephalitis with EpilepsyMohankumar Kurukumbi0Rahul H. Dave1Jose Castillo2Tulsi Shah3Joanne Lau4Department of Neurology, Inova Fairfax Hospital, Falls Church, VA, USADepartment of Neurology, Inova Fairfax Hospital, Falls Church, VA, USAVirginia Commonwealth University School of Medicine, Inova Campus, Falls Church, VA, USAVirginia Commonwealth University School of Medicine, Inova Campus, Falls Church, VA, USAVirginia Commonwealth University School of Medicine, Inova Campus, Falls Church, VA, USAIntractable epilepsy remains a significant medical challenge, resulting in recurrent and prolonged intensive care unit (ICU) admissions. Autoimmune encephalitis is emerging as a treatable cause of intractable epilepsy. It is characterized by antibodies against cerebral antigens, such as potassium channels such as leucine-rich, glioma inactivated 1 (LGI1) and contactin-associated protein 2 (CASPR2), calcium channels such as the voltage-gated calcium channel (VGCC), or neurotransmitter receptors such as the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), gamma aminobutyric acid receptor (GABAR), and N-methyl-D-aspartate receptor (NMDAR). Diagnosis requires a syndrome consistent with an antibody identified in serum or cerebrospinal fluid (CSF) using methods that minimize risk of false-positives. Although there is no officially approved therapy for these disorders, typical approaches involve chronic high-dose steroids, intravenous immunoglobulin (IVIG), or plasma exchange. Rituximab is effective for antibody-associated disorders such as lupus, myasthenia gravis, and neuromyelitis optica. Here, we present three patients who were admitted with recalcitrant status epilepticus and demonstrated serum antibodies against NMDAR, LGI1, or VGCC using a cell-based assay. All patients demonstrated complete, long-term epilepsy control and improvement in symptoms with rituximab.http://dx.doi.org/10.1155/2020/5843089 |
| spellingShingle | Mohankumar Kurukumbi Rahul H. Dave Jose Castillo Tulsi Shah Joanne Lau Rituximab for Autoimmune Encephalitis with Epilepsy Case Reports in Neurological Medicine |
| title | Rituximab for Autoimmune Encephalitis with Epilepsy |
| title_full | Rituximab for Autoimmune Encephalitis with Epilepsy |
| title_fullStr | Rituximab for Autoimmune Encephalitis with Epilepsy |
| title_full_unstemmed | Rituximab for Autoimmune Encephalitis with Epilepsy |
| title_short | Rituximab for Autoimmune Encephalitis with Epilepsy |
| title_sort | rituximab for autoimmune encephalitis with epilepsy |
| url | http://dx.doi.org/10.1155/2020/5843089 |
| work_keys_str_mv | AT mohankumarkurukumbi rituximabforautoimmuneencephalitiswithepilepsy AT rahulhdave rituximabforautoimmuneencephalitiswithepilepsy AT josecastillo rituximabforautoimmuneencephalitiswithepilepsy AT tulsishah rituximabforautoimmuneencephalitiswithepilepsy AT joannelau rituximabforautoimmuneencephalitiswithepilepsy |