抗N-甲基-D-天冬氨酸(NMDA)受体脑炎是一种自身免疫性脑炎(AE),其特征是针对NMDA受体的抗体。作为最常见的AE,抗NMDAR脑炎影响54%〜80%的AE患者。它与高比例的严重疾病相关。它通常表现为行为和精神障碍,癫痫,认知能力下降,意识水平下降,非自愿运动,自主神经功能障碍,中枢通气不足,等。我们报告了两种难治性抗NMDAR脑炎。其中之一描述了与MOG抗体共存的抗NMDA脑炎的情况。两名患者接受了糖皮质激素和静脉注射免疫球蛋白的一线治疗,但临床上没有改善。因此,患者改用全人抗CD20单克隆抗体,Ofatumumab。他们的意识,行为和精神障碍,在使用Ofatumumab进行序贯治疗后,执行日常任务的能力显着提高,如改良Rankin量表(mRS)评分所示。第一次,我们报道了使用全人抗CD20单克隆抗体ofatumumab治疗难治性抗NMDAR脑炎的成功方法,作为AE治疗的重要参考。
Anti-N-methyl-D-aspartate (
NMDA) receptor encephalitis is a type of autoimmune encephalitis (AE) characterized by antibodies against
NMDA receptor. As the most common AE, anti-NMDAR encephalitis affects 54% ~ 80% of patients with AE. It is associated with a high percentage of severe illness. It typically manifests as behavioral and psychiatric disturbance, epilepsy, cognitive decline, decreased level of consciousness, involuntary movements, autonomic dysfunction, central hypoventilation, etc. We report two refractory anti-NMDAR encephalitis. One of them describes a
case of anti-
NMDA encephalitis coexisting with MOG antibodies. The two patients were administered first-line therapy with glucocorticoids and intravenous immunoglobulin but did not improve clinically. Therefore, the patient was switched to the fully human anti-CD20 monoclonal antibody, ofatumumab. Their consciousness, behavioral and psychiatric disturbance, and capacity to conduct daily tasks improved markedly after sequential therapy with ofatumumab, as demonstrated by the modified Rankin scale (mRS) score. For the first time, we report a successful approach to the treatment of refractory anti-NMDAR encephalitis using the fully human anti-CD20 monoclonal antibody ofatumumab, which serves as an important reference for the treatment of AE.