Blood (serum) and cerebral spinal fluid (CSF) antibody titres should also be seen to decrease with adequate treatment response. This is followed in many cases by steroid-sparing agents such as Cellcept or Azathioprine in the long-term. The fact that patients who receive second-line immunotherapies have fewer relapses, is leading many physicians to use rituximab initially as a first-line treatment.Ĭlinical improvement, an improvement of MRI, and EEG findings may be used to assess the success of treatment. Those who remain refractory to first and second line treatment have benefited from Third-line/experimental treatments: IL6 blockade ( tocilizumab) or plasma cell-specific therapy (proteasome inhibitors) or bortezomib, a treatment that depletes plasma cells. Second-line therapies: Rituxamab (Rituxan) and cyclophosphamide (Cytoxan). Treatment should begin swiftly. Immunotherapy treatment is the combination of treatments that include first-line therapies: steroids, IVIG, plasma exchange (plasmapheresis), and resection of any underlying tumor are of primary importance. However, treatment for autoimmune encephalitis is a marathon and not a sprint as treatment is on-going and usually involves several combinations of treatment in the protocol. Many patients experience the return of mental clarity after their initial 3-5 days of one gram IV Solumedrol. Initially, high dose steroids are used to slow down the immune system and bring down the inflammation in the brain in a broad way. There is no uniform standard immunotherapy. Suppressing the immune system attempts to stop the attack that is occurring. By slowing down the immune system it slows down the process the immune system is engaging in, which is creating the foreign antibodies that are attacking healthy brain cells. Immunotherapy slows down the over-excited immune system.
The treatment of patients should be multidisciplinary and involve neurologists, as well as N euroimmunologists, oncologists, rheumatologists, and psychiatrists. Autoimmune Encephalitis is t reated with immunotherapy.