التهاب الدماغ المضاد لمستقبلات NMDA عند الأطفال: البروتوكول عندما لا يُحقق العلاج المناعي من الخط الأول تحسنًا كافيًا

References

DOI: 10.1212/NXI.0000000000001052

Severe is defined by issues affecting SAFETY and FUNCTION. Any (≥1) of the severity markers present below (items a–i) scoring “severe” rather than “standard” would classify as severe disease.

In patients who are failing to improve approximately 2 wk after initiation of 2 or more first-line therapies, second-line therapy is favored over further first-line therapies.

Rituximab (RTX) is generally the second-line therapy of choice. Cyclophosphamide (CYC) may be considered if RTX is contraindicated or not available.

Another second-line therapy (i.e., CYC, if RTX was used first, or vice versa) can be used in any patient with severe disease who fails to improve adequately 1–3 mo following initiation of the first second-line immunotherapy.