Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar:164:110280.
doi: 10.1016/j.yebeh.2025.110280. Epub 2025 Feb 1.

Use of intrathecal rituximab in autoimmune epilepsy: A retrospective study

Christina Wombles  1 , Emilyn Ballard  1 , Holly Skinner  1 , Angel Claudio  1 , Ki Hyeong Lee  1 , Mahammed Z Khan Suheb  2 , Okorie Okorie  3 , Amay Parikh  3 , Raad Bassel  3 , Elakkat D Gireesh  1
Affiliations

Use of intrathecal rituximab in autoimmune epilepsy: A retrospective study

Christina Wombles et al. Epilepsy Behav. 2025 Mar.

Abstract

Background: Autoimmune encephalitis (AE) is a significant challenge in neurological practice, often proving refractory to conventional treatments. It typically manifests with recurrent seizures or status epilepticus, necessitating early diagnosis and tailored therapy for optimal outcomes. Early institution of effective treatment has been reported to reduce the mortality and morbidity associated with this condition. A subpopulation presenting with acute seizures due to autoimmune encephalitis later develop chronic epilepsy, which can be refractory to conventional modes of treatments. In addition, there is a group of chronic epilepsy patients who did not have acute symptomatic seizures who have autoimmune antibodies suggesting an immunological origin of their seizures. This study aims at evaluating the use of rituximab administered intrathecally, for treating these patients, taking pharmacodynamic properties into account.

Materials and methods: We retrospectively evaluated the efficacy and safety of intrathecal rituximab (ITR) in 15 patients with autoimmune-related epilepsy (9 of them with acute presentation with seizures and 6 with chronic intractable epilepsy). The nature of these seizures, laboratory findings, imaging and EEG findings were compared over the course of treatment and follow up.

Results: No significant long term side effects related to administration of ITR were noted in the 15 patients reported in this series. Improvement was noted in seizure control in the majority of the patients, especially in the acute presentation category, although definitive conclusions about efficacy could not be made since these patients were also receiving additional modes of therapies. Better seizure control was noted in all patients in 12 months follow up.

Conclusions: Our findings underscore the safety of intrathecal rituximab in treating autoimmune-related status epilepticus and refractory epilepsy related to autoimmune etiology.

Keywords: Autoimmune encephalitis; Intrathecal rituximab; Refractory epilepsy.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.