Autoimmune Encephalitis: First-Line Treatment Options and Comprehensive Management

Autoimmune encephalitis is a complex neurological condition that requires prompt and effective treatment. The first-line therapeutic approach typically involves immunomodulatory interventions such as corticosteroids, intravenous immunoglobulin (IVIG), and plasma exchange. These treatments are widely recognized as the cornerstone in managing autoimmune encephalitis, aiming to reduce inflammation and modulate the immune response.

Second-Line Therapies for Refractory Cases

When patients do not respond adequately to initial treatments, second-line therapies become necessary. Commonly prescribed medications in such scenarios include rituximab and azathioprine. These agents target specific components of the immune system to achieve better disease control. For individuals experiencing relapses, long-term immunosuppressive therapy may be required, often involving mycophenolate mofetil or azathioprine to prevent further episodes.

Management of Associated Symptoms

In addition to immunotherapy, symptom management plays a crucial role in the overall care of patients with autoimmune encephalitis. Many patients develop epilepsy as a comorbidity, which can be effectively managed with antiepileptic drugs such as levetiracetam. For those exhibiting psychiatric symptoms, especially in cases of anti-NMDA (N-methyl-D-aspartate) receptor encephalitis, appropriate psychiatric medications should be administered to address behavioral and cognitive disturbances.

Consideration of Underlying Tumors

Particular attention should be given to the presence of teratomas in patients with anti-NMDA receptor encephalitis. If a teratoma is detected, surgical removal of the tumor is a critical component of the treatment plan, as it can significantly improve neurological outcomes and reduce the risk of relapse.