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The following is a summary of “Efficacy of double filtration plasmapheresis in the treatment of steroid and/or IVIG unresponsive neuronal surface antibodies associated autoimmune encephalitis,” published in the December 2024 issue of Neurology by Liang et al.
Autoimmune encephalitis (AE), a severe neurological condition associated with neuronal surface antibodies, can be challenging to treat when individuals do not respond to corticosteroids or intravenous immunoglobulin (IVIG).
Researchers conducted a retrospective study to evaluate the efficacy and safety of double filtration plasmapheresis (DFPP) for individuals with AE who did not improve with initial immunotherapy.
They reviewed 26 individuals diagnosed with AE who received DFPP after showing no improvement with at least 21 days of treatment involving high-dose corticosteroids, IVIG, or immunosuppressants. Effectiveness was assessed using the modified Rankin Scale (mRS) within 1 week after treatment and complications were recorded.
The results showed clinically relevant improvement in 57.7% of individuals after DFPP, with a median reduction in the mRS score from 5 to 4 within 1 week (P<0.001), DFPP was started at a median of 54.5 days (range 21–243 days) after symptom onset. Individuals received a median of 3 sessions (range 2–6 sessions), with an average plasma exchange volume of 50.5 ± 11.1 ml/kg per session. Only 1 person experienced a relapse within 6 months. Effectiveness was not associated with age, gender, antibody type, the presence of neoplasm, clinical course, or plasma exchange volume, 2 individuals experienced mild complications: 1 had an allergic reaction, and another had transient low blood pressure, which managed promptly.
They concluded that DFPP was a safe and effective treatment for individuals with AE who do not respond to initial immunotherapy.
Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-024-03971-y
