The three pillars in treating antibody-mediated encephalitis

Abstract

The rapid initiation of immunotherapy has a decisive impact on the course of the disease in patients with antibody-mediated encephalitis (AE). The importance of treating AE with antiseizure medication and antipsychotics is discussed controversially; however, standardized procedures should be ensured, especially for the initiation of treatment in severe disease. Recommendations and guidelines for further interventions in refractory courses are needed. In this review, we contrast the three mainstays of treatment options in patients with AE and attempt to highlight the importance of 1) antiseizure therapy, 2) antipsychotic therapy, and 3) immunotherapy/tumor resection from today's perspective.

Keywords: Antineuronal antibodies; Antipsychotics; Autoimmune encephalitis; Epilepsy; Immunotherapy.

Fig. 1

Treatment algorithm for status epilepticus (SE). Green/1st: First-line therapy of SE with benzodiazepines, Yellow/2nd: First choice treatment of benzodiazepine refractory SE, Red/3rd: Treatment of refractory SE, Brown/4th: Treatment options of superrefractory SE. Asterisk repeat once if necessary, Rhombus not available in Austria/Germany

Fig. 2

Immunotherapeutic treatment options. i.v. intravenous, s.c. subcutaneous; Green: Standard first line treatment, single use or in combination; Blue: Standard second line treatment with the most experience in the treatment of AE in case of failure of first line therapy, single use or in combination; Yellow: Other second line therapy options with less experience and future therapy options; Red: Therapy escalation to 3rd line therapy with the greatest experience in refractory disease with anti-NMDARE