engleski

Autoimmune encephalitis - therapeutic dilemmas

Autoimmune limbic encephalitis is a form of encephalitis characterized by specific antibodies to cell-surface antigens, specific clinical presentation and, in some cases, connection with different neoplasms. One of the main clinical characteristics are temporal lobe seizures. The fever-induced refractory epileptic encephalopathy syndrome (FIRES) and new onset refractory status epilepticus (NORSE) are very often characterized by development of super-refractory status epilepticus and fatal outcome. Although the etiology of the mentioned seizures is unknown, it is possible that it is connected with some form of autoimmune disorder, which should be confirmed by further investigations. Therapeutic guidelines recommend corticosteroids, immunotherapy and cyclophosphamide as the last therapeutic choice for both disorders, but there is still a question when to start to treat, what the first therapeutic line is, and also how aggressively to treat. Despite a number of published papers that describe individual experiences, there are still no clear therapeutic algorithms. In this paper, we present our experiences in the treatment of patients with autoimmune encephalitis. We think that therapy should be more aggressive and, sometimes, in the beginning of treatment, we suggest combined immunotherapy. In the cases of unsatisfactory results of treatment, we suggest quick switch to another kind of immunotherapy because the mentioned disorders have unfortunately a high rate of mortality and are associated with major disability. Sometimes the choice of therapy depends on the etiology of the mentioned diseases.

autoimmune envephalitis; epilepsy

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