Relapse of NMDA Receptor Antibody Encephalitis in Children Under 18
Clinical Scenario
This protocol addresses children younger than 18 years who experience a relapse of NMDA receptor antibody encephalitis — that is, the return of previously resolved symptoms and signs, or the appearance of new symptoms or signs, associated with a change in function.
Relapse is defined as: return of previously resolved symptoms and signs, or appearance of new symptoms or signs, associated with change in function, lasting more than 1 week (or shorter if associated with a change in safety), that cannot be explained by adverse reactions to current medications or intercurrent illness, after a period of stability or improvement of at least 1 month.
Treatment Approach
Current evidence supports first-line immunotherapy for all children with NMDA receptor antibody encephalitis relapse — including those who are already improving at the time of diagnosis. Combinations of first-line immunotherapy approaches are available and may be used as clinically indicated.
The full sequence, specific agents, and combination strategy are detailed in the complete protocol →
References
- Return of previous resolved symptoms and signs, or appearance of new symptoms or signs, associated with change in function, lasting more than 1 wk (or shorter if associated with change in safety), that cannot be explained by adverse reactions to current medications or intercurrent illness, after a period of stability or improvement of at least 1 mo.
- First-line immunotherapy should be offered to all children with NMDARE relapse, even if they are improving at the time of diagnosis (i.e., late diagnosis or rapid improvement and remission). First-line immunotherapy and combinations can be used as per Table 2, 2.2.
DOI: 10.1212/NXI.0000000000001052
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