Kalra Anahat, Mackay Olivia, Thomas-Jones Emma, Solomon Tom, Foscarini-Craggs Paula
School of Medicine, Cardiff University, Cardiff, UK.
Brain Behav. 2025 May;15(5):e70491. doi: 10.1002/brb3.70491.
Autoimmune encephalitis is an immune-mediated inflammatory condition affecting the central nervous system. Current best-practice guidelines recommend intravenous immunoglobulin (IVIG) for use if corticosteroids are ineffective, but the evidence surrounding the efficacy of IVIG in autoimmune encephalitis is yet to be evaluated.
Perform a systematic review of the available literature to evaluate the efficacy of IVIG in autoimmune encephalitis and the impact of IVIG on clinical outcomes.
This systematic review was written following PRISMA-S guidelines. Papers eligible for inclusion were primary research including adults aged 16 years and above, with a suspected or confirmed diagnosis of autoimmune encephalitis, treated using IVIG. Each included study was assessed for quality.
From 2533 records, 27 studies met the inclusion criteria. The use of IVIG is associated with improved short-term and long-term neurological outcomes. There is evidence that IVIG may be more effective when used in combination with corticosteroids. The use of IVIG is significantly associated with reduced seizure incidence in patients. Where recorded, adverse effects related to IVIG were few. There is insufficient data available on how IVIG impacts mortality rates, discharge rates, and its effects according to different types of autoimmune encephalitis. Out of the included papers, there was 1 randomized controlled trial (RCT), 3 nonrandomized trials and 23 cohort studies. 25 of 27 papers were deemed to have a high or serious risk of bias. Heterogeneous study design and the quality of studies were major limiting factors for this review, highlighting the need for further research.
自身免疫性脑炎是一种影响中枢神经系统的免疫介导的炎症性疾病。目前的最佳实践指南建议，如果皮质类固醇无效，则使用静脉注射免疫球蛋白（IVIG），但关于IVIG在自身免疫性脑炎中疗效的证据尚未得到评估。
对现有文献进行系统评价，以评估IVIG在自身免疫性脑炎中的疗效以及IVIG对临床结局的影响。
本系统评价按照PRISMA-S指南撰写。符合纳入标准的论文为主要研究，包括16岁及以上疑似或确诊自身免疫性脑炎且使用IVIG治疗的成年人。对每项纳入研究进行质量评估。
从2533条记录中，有27项研究符合纳入标准。使用IVIG与改善短期和长期神经学结局相关。有证据表明，IVIG与皮质类固醇联合使用时可能更有效。使用IVIG与患者癫痫发作发生率降低显著相关。记录显示，与IVIG相关的不良反应很少。关于IVIG如何影响死亡率、出院率以及根据不同类型自身免疫性脑炎的影响，现有数据不足。在纳入的论文中，有1项随机对照试验（RCT）、3项非随机试验和23项队列研究。27篇论文中有25篇被认为存在高或严重的偏倚风险。研究设计的异质性和研究质量是本次评价的主要限制因素，突出了进一步研究的必要性。
