College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.
Division of Pediatric Neurology, Department of Pediatrics, King Abdullah Specialist Children's Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia.
BMC Neurol. 2023 Jul 7;23(1):261. doi: 10.1186/s12883-023-03301-8.
Anti-N-methyl-d-aspartate "anti-NMDA" receptor encephalitis is one of the most common autoimmune encephalitis for which first- and second-line therapies have been recommended following international consensus. However, some refractory cases do not respond to the first- and second-line therapy and require further immune-modulatory therapies such as intra-thecal methotrexate. In this study, we reviewed six confirmed cases of refractory anti-NMDA receptor encephalitis from two tertiary centers in Saudi Arabia that required escalation of treatment and received a six-month course of intra-thecal methotrexate. The aim of this study was to evaluate the effectiveness of intra-thecal methotrexate as immunomodulatory therapy for refractory anti-NMDA receptor encephalitis.
We retrospectively evaluated six confirmed cases of refractory anti-NMDA receptor encephalitis who did not improve after first- and second-line therapy and received monthly intra-thecal methotrexate treatment course for six consecutive months. We reviewed patient demography, underlying etiologies, and compared their modified Rankin score prior to receiving intra-thecal methotrexate and six months after completing the treatment.
Three of the six patients showed a marked response to intra-thecal methotrexate with a modified Rankin scale of 0-1 at 6-month follow-up. None of the patients experienced any side effects during or after intra-thecal methotrexate treatment, and no flareups were observed.
Intra-thecal methotrexate may be a potentially effective and relatively safe escalation option for immunomodulatory therapy of refractory anti-NMDA receptor encephalitis. Future studies on intra-thecal methotrexate -specific treatment regimens may further support its utility, efficacy, and safety in treating refractory anti-NMDA receptor encephalitis.
抗 N-甲基-D-天冬氨酸（“抗 NMDA”）受体脑炎是最常见的自身免疫性脑炎之一，国际共识推荐了一线和二线治疗方法。然而，一些难治性病例对一线和二线治疗无反应，需要进一步的免疫调节治疗，如鞘内注射甲氨蝶呤。在这项研究中，我们回顾了来自沙特阿拉伯两家三级中心的 6 例确诊的难治性抗 NMDA 受体脑炎病例，这些病例需要升级治疗，并接受了 6 个月的鞘内注射甲氨蝶呤治疗。本研究旨在评估鞘内注射甲氨蝶呤作为难治性抗 NMDA 受体脑炎免疫调节治疗的有效性。
我们回顾性评估了 6 例确诊的难治性抗 NMDA 受体脑炎病例，这些病例在一线和二线治疗后未改善，并接受了每月一次的鞘内注射甲氨蝶呤治疗，连续 6 个月。我们回顾了患者的人口统计学、潜在病因，并比较了他们在接受鞘内注射甲氨蝶呤之前和完成治疗后 6 个月的改良 Rankin 评分。
6 例患者中有 3 例对鞘内注射甲氨蝶呤有明显反应，在 6 个月的随访中改良 Rankin 评分为 0-1。在鞘内注射甲氨蝶呤治疗期间或之后，没有患者出现任何副作用，也没有出现疾病复发。
鞘内注射甲氨蝶呤可能是一种有效的、相对安全的难治性抗 NMDA 受体脑炎免疫调节治疗的升级选择。未来关于鞘内注射甲氨蝶呤特定治疗方案的研究可能进一步支持其在治疗难治性抗 NMDA 受体脑炎中的有效性、疗效和安全性。
