Kahn Ilana, Helman Guy, Vanderver Adeline, Wells Elizabeth
1 Department of Neurology, Children's National Health System, NW, Washington, DC, USA.
2 Children's Research Institute, NW, Washington, DC, USA.
J Child Neurol. 2017 Feb;32(2):243-245. doi: 10.1177/0883073816675557. Epub 2016 Nov 22.
Anti- N-methyl-d-aspartate receptor (NMDAR) encephalitis has been shown to be a treatable form of autoimmune encephalitis, but there remains no standardized approach to immunotherapy. We designed an anonymous survey sent to members of the Child Neurology Society to identify the current practices among child neurologists. A total of 151 pediatric neurologists responded to the survey. With these responses we were able to highlight areas of practice uniformity, including first-line treatment with intravenous immunoglobulin and intravenous methylprednisone and initiation of disease-modifying therapy with rituximab alone. The survey also identifies existing gaps in knowledge, specifically, when to add disease-modifying therapy and how long to continue therapy. We propose that the areas of agreement can be used as a step toward establishing standard treatment guidelines and research protocols directed at evidence-based clinical trials.
抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎已被证明是一种可治疗的自身免疫性脑炎形式,但免疫治疗仍没有标准化方法。我们设计了一项匿名调查,发送给儿童神经学会成员,以确定儿童神经科医生目前的治疗方法。共有151名儿科神经科医生回复了调查。通过这些回复,我们能够突出实践一致性的领域,包括静脉注射免疫球蛋白和静脉注射甲基强的松龙作为一线治疗,以及单独使用利妥昔单抗启动疾病改善治疗。该调查还确定了现有知识差距,特别是何时添加疾病改善治疗以及持续治疗多长时间。我们建议,达成共识的领域可作为朝着建立基于循证临床试验的标准治疗指南和研究方案迈出的一步。