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Efficacy of Therapeutic Plasma Exchange in Patients with Severe Refractory Anti-NMDA Receptor Encephalitis

  • Yan ZhangEmail author
  • Gang Liu
  • Mengdi Jiang
  • Weibi Chen
  • Yingying Su
Original Article

Abstract

The objective of the present study was to assess the efficacy of therapeutic plasma exchange (TPE) in patients with severe refractory anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis. Patients with severe anti-NMDA receptor encephalitis who showed no improvement after steroids and/or intravenous immunoglobulin treatment for at least 10 days were enrolled. All patients received immunotherapy and were divided into a TPE group and a non-TPE group according to treatment received. Each patient in the TPE group received at least 1 TPE course. NMDA receptor antibody titers in the cerebrospinal fluid (CSF) and plasma were evaluated within 1 week after the last TPE procedure. The clinical efficacy of treatment was evaluated after 1 month, 2 months, 3 months, 6 months, and 12 months. Forty patients were enrolled: 19 in the TPE group and 21 in the non-TPE group. Nineteen patients received TPE for a total of 118 procedures. NMDA receptor antibody titers in the CSF and/or plasma decreased or were negative after the last TPE procedure in 18 patients (94.7%). Compared with the non-TPE group, the TPE group exhibited greater clinical improvement after 1 month and 2 months following treatment (P < 0.05). After 3 months, 6 months, and 12 months, there were no significant differences in the outcomes between the TPE group and non-TPE group. The results suggest that TPE might rapidly improve the clinical manifestations in patients with severe refractory anti-NMDA receptor encephalitis, and we believe that TPE should be considered as a first-line treatment.

Key Words

Anti-N-methyl-D-aspartate receptor encephalitis therapeutic plasma exchange severe refractory outcome 

Notes

Acknowledgements

This project was supported by the Chinese Natural Science Fund No. 81671037 (to Yingying Su). We thank Dr. Hongzhi Guan, Dr. Haitao Ren, and Dr. Yanhuan Zhao from the Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, China, for performing anti-NMDA receptor antibody assays and for technical support.

Compliance with Ethical Standards

This study was approved by the Ethics Committee of Xuanwu Hospital, Capital Medical University, adhered to the tenets of the Declaration of Helsinki.

Conflict of Interest

The authors declare that they have no conflict of interest.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

13311_2019_725_MOESM1_ESM.pdf (1.8 mb)
ESM 1 (PDF 1861 kb)

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Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2019

Authors and Affiliations

  • Yan Zhang
    • 1
    Email author
  • Gang Liu
    • 1
  • Mengdi Jiang
    • 1
  • Weibi Chen
    • 1
  • Yingying Su
    • 1
  1. 1.Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina

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