Controversies in immunotherapy for anti-NMDA receptor encephalitis: a scoping review with a proposal of operational definitions.
Geovanni Guimarães BandeiraPedro Lucas Grangeiro de Sá Barreto LimaDavid Augusto Batista Sá AraújoMaria Suelly Nogueira PinheiroLuciano de Albuquerque MotaRafael Machado SimãoFrancisco Matheus Oliveira de CarvalhoFernando Degani VazquezVitor Carneiro de Vasconcelos GamaDánton Campos de QueirozMatheus Zaian Rodrigues da Fonseca LiraPedro Helder de Oliveira JúniorFernando Antônio Guimarães JuniorGabrielle Cavalcante CaminhaCarolina de Figueiredo SantosManoel Alves Sobreira-NetoPedro Braga-NetoGuilherme Diogo SilvaPaulo Ribeiro NóbregaPublished in: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (2023)
Anti-NMDA receptor encephalitis (NMDARE), an autoimmune encephalitis associated with autoantibodies against the N-methyl-D-aspartate (NMDA) receptor, affects predominantly young women and is associated with psychiatric symptoms, seizures, movement disorders, and autonomic instability. Traditional treatments of anti-NMDA receptor encephalitis involve corticosteroids, intravenous immunoglobulin, plasmapheresis, cyclophosphamide, and rituximab. However, many controversies remain in the treatment for NMDA receptor encephalitis, such as optimal timing and combination of different immunotherapies, the role of newer strategies (e.g., bortezomib or tocilizumab) for severe and refractory patients, and the need or not for long-term immunosuppression. Our goal was to perform a scoping review to discuss the controversial topics of immunotherapy for NMDA receptor encephalitis and propose operational definitions to guide clinical practice and future research in the field.
Keyphrases
- end stage renal disease
- newly diagnosed
- clinical practice
- high dose
- chronic kidney disease
- rheumatoid arthritis
- ejection fraction
- multiple sclerosis
- systemic lupus erythematosus
- low dose
- mental health
- early onset
- peritoneal dialysis
- current status
- patient reported outcomes
- sleep quality
- patient reported
- replacement therapy