Shin Hye-Rim, Jang Yoonhyuk, Shin Yong-Won, Chu Kon, Lee Sang Kun, Lee Soon-Tae
Department of Neurology (YJ, Y-WS, KC, SKL, S-TL), Seoul National University Hospital; Department of Neurology (H-RS), Dankook University Hospital, Cheonan; and Department of Neurosurgery (Y-WS), Seoul National University Hospital, South Korea.
Neurol Clin Pract. 2021 Aug;11(4):e480-e487. doi: 10.1212/CPJ.0000000000001001.
Because there is no standard treatment to control dyskinesia in anti-NMDA receptor (NMDAR) encephalitis, we analyzed the therapeutic efficacy of high-dose diazepam in dyskinesia associated with NMDAR encephalitis.
We reviewed patients with NMDAR encephalitis with dyskinesia who were admitted to Seoul National University Hospital between November 2012 and July 2018. High-dose diazepam was administered orally or via a nasogastric tube 3-6 times a day. We assessed the treatment effect by comparing dyskinesia severity between the first day of the highest dose of diazepam and one week after the treatment.
Among 68 patients with NMDAR encephalitis during the study period, 33 patients were treated with enteral diazepam (ranging from 6 to 180 mg) to control dyskinesia, along with immunotherapy. The severity of dyskinesia improved from average grade 2.4 ± 0.6 to 1.1 ± 0.7 after 1 week of the highest dose of diazepam (mean severity change -1.4 ± 0.6, 95% confidence interval -1.2 to -1.6; < 0.001). No patients had serious adverse events except for mild sedation.
Dyskinesia in NMDAR encephalitis improved after treatment with enteral diazepam without significant side effects. This study suggests that enteral diazepam could be a treatment option for control dyskinesia in NMDAR encephalitis.
This study provides Class IV evidence that for patients with dyskinesias associated with NMDAR encephalitis, enteral diazepam is effective and safe in dyskinesia control.
由于抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎中尚无控制异动症的标准治疗方法，我们分析了大剂量地西泮治疗NMDAR脑炎相关异动症的疗效。
我们回顾了2012年11月至2018年7月期间入住首尔国立大学医院的患有异动症的NMDAR脑炎患者。大剂量地西泮通过口服或鼻胃管给药，每天3 - 6次。我们通过比较地西泮最高剂量首日与治疗后一周的异动症严重程度来评估治疗效果。
在研究期间的68例NMDAR脑炎患者中，33例患者接受了肠内地西泮（剂量为6至180毫克）治疗以控制异动症，同时接受免疫治疗。在给予地西泮最高剂量1周后，异动症严重程度从平均2.4±0.6级改善至1.1±0.7级（平均严重程度变化 -1.4±0.6，95%置信区间 -1.2至 -1.6；P<0.001）。除轻度镇静外，无患者出现严重不良事件。
肠内地西泮治疗后，NMDAR脑炎的异动症得到改善，且无明显副作用。本研究表明，肠内地西泮可能是控制NMDAR脑炎异动症的一种治疗选择。
本研究提供了IV级证据，表明对于NMDAR脑炎相关异动症患者，肠内地西泮在控制异动症方面有效且安全。
