Şorodoc Victoriţa, Constantin Mihai, Asaftei Andreea, Lionte Cătălina, Ceasovschih Alexandr, Sîrbu Oana, Haliga Raluca Ecaterina, Şorodoc Laurenţiu
2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania.
Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
Front Neurol. 2023 Sep 7;14:1243787. doi: 10.3389/fneur.2023.1243787. eCollection 2023.
Hashimoto's encephalopathy (HE) is a controversial immunological neuropsychiatric disease, with a poorly understood pathogenesis. It is characterized by symptoms of acute or subacute encephalopathy which usually occur in the presence of elevated levels of antithyroid antibodies. Even though it is also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), some cases appear to be steroid-resistant. This review examined whether treatment of Hashimoto's encephalopathy with intravenous immunoglobulin (IVIG) is associated with better clinical outcomes than the standard therapy. Additionally, we presented a case of a 59-year-old man who presented with severe neurological manifestations and was successfully treated with intravenous immunoglobulin.
The online databases PubMed and EMBASE were searched.
A total of 1,365 articles were identified. After the deletion of 112 duplicates, 1,253 studies were screened by evaluating the title and abstract, focusing on Hashimoto's encephalopathy cases where IVIG were used. 846 studies were excluded because they were not relevant to the topic or included pediatric population. Therefore, 407 full-text articles were assessed for eligibility. The final analysis included 14 eligible articles after 393 were excluded (irrelevant texts, not written in English, full-text not available). In the majority of the selected case-reports, IVIG was associated with a good outcome, sometimes even with dramatic improvements in patient's status.
In last years, intravenous immunoglobulin therapy proved its utility in Hashimoto's encephalopathy's treatment, being a well tolerated therapy associated with remarkable improvement in patient's status. Further research is still needed in order to define the optimal treatment protocol for Hashimoto's encephalopathy and to establish if intravenous immunoglobulin can also be used as a first-line therapy, alone or in combination with steroids.
桥本脑病（HE）是一种存在争议的免疫性神经精神疾病，其发病机制尚不清楚。其特征为急性或亚急性脑病症状，通常在抗甲状腺抗体水平升高时出现。尽管它也被称为与自身免疫性甲状腺炎相关的类固醇反应性脑病（SREAT），但有些病例似乎对类固醇耐药。本综述探讨了静脉注射免疫球蛋白（IVIG）治疗桥本脑病是否比标准疗法具有更好的临床疗效。此外，我们报告了一例59岁男性患者，其出现严重神经症状并通过静脉注射免疫球蛋白成功治愈。
检索在线数据库PubMed和EMBASE。
共识别出1365篇文章。删除112篇重复文章后，通过评估标题和摘要筛选出1253项研究，重点关注使用IVIG的桥本脑病病例。846项研究因与主题无关或纳入了儿科人群而被排除。因此，对407篇全文文章进行了资格评估。在排除393篇（无关文本、非英文撰写、无全文）后，最终分析纳入了14篇符合条件的文章。在大多数选定的病例报告中，IVIG与良好的预后相关，有时甚至使患者状况有显著改善。
近年来，静脉注射免疫球蛋白疗法已证明其在桥本脑病治疗中的效用，是一种耐受性良好的疗法，可使患者状况显著改善。仍需要进一步研究以确定桥本脑病的最佳治疗方案，并确定静脉注射免疫球蛋白是否也可单独或与类固醇联合用作一线治疗。
