Treatment Options for Autoimmune Encephalitis

Autoimmune encephalitis is a complex condition that requires a multi-faceted treatment approach. The therapeutic strategy typically includes immunotherapy, tumor management, seizure control, and psychiatric support, along with general supportive and rehabilitation care. Each treatment plan should be tailored to the individual patient's needs and medical history.

Immunotherapy Approaches

Immunotherapy is a cornerstone in the treatment of autoimmune encephalitis and is categorized into first-line, second-line, and long-term therapies. First-line treatments often involve corticosteroids, intravenous immunoglobulins (IVIG), or plasma exchange, which help reduce inflammation and modulate the immune response. For patients who do not respond adequately to initial therapies, second-line treatments such as rituximab or intravenous cyclophosphamide may be introduced. Long-term immunosuppressive therapies, including mycophenolate mofetil and azathioprine, are typically reserved for patients with recurrent disease to prevent future flare-ups.

Tumor Management

In cases such as anti-NMDA receptor encephalitis, prompt identification and removal of associated tumors—like ovarian teratomas—is critical. If no tumor is initially detected, women over the age of 12 are generally advised to undergo regular pelvic ultrasound examinations every 6 to 12 months for up to four years after the onset of symptoms. Patients with confirmed malignancies should receive coordinated care from oncology specialists. During cancer treatment, it is essential to continue immunotherapy for autoimmune encephalitis, primarily using first-line regimens, to maintain neurological stability.

Seizure Management

Addressing Epileptic Activity

Epileptic seizures associated with autoimmune encephalitis often do not respond well to conventional antiepileptic drugs. In such cases, broad-spectrum anticonvulsants like benzodiazepines, valproate, or levetiracetam may be more effective. These medications are typically selected based on their efficacy in managing refractory seizures and their favorable side effect profiles.

Psychiatric and Behavioral Symptom Management

Psychiatric manifestations, including hallucinations, agitation, or mood disturbances, can be managed with medications such as olanzapine, clonazepam, valproate, or quetiapine. Close monitoring is required due to potential side effects like sedation, altered consciousness, and extrapyramidal symptoms. Once immunotherapy begins to take effect, antipsychotic medications should be gradually tapered off under medical supervision. Treatment decisions should always be individualized, with adjustments made according to the patient's clinical response and physician guidance.