Efficacy And Safety Of Plasma Exchange In The Treatment Of Refractory Severe Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Objective: To investigate the clinical efficacy and safety of plasma exchange combined with other immunotherapy for refractory severe anti-N-methyl-D-aspartate receptor encephalitis.Methods: The clinical data of 16 patients with refractory severe anti-NMDA receptor encephalitis treated in the first affiliated Hospital of Guangxi Medical University and the second affiliated Hospital of Guangxi Medical University from January 2015 to December 2018 were collected.The clinical data included basic information,clinical manifestations,auxiliary examination,treatment,adverse reactions and prognosis(modified Rankin score).These clinical data were analyzed retrospectively.All the 16 patients were positive for CSF anti-NMDA receptor antibody,of which 11 were positive for anti-NMDA receptor antibody and 5 were negative for NMDA receptor antibody.RESULTS: There were 16 patients with severe anti-NMDA receptor encephalitis,including 10 males and 6 females,aged from 17 to 52 years old,with an average of(28.81 ? 11.50)years old.All patients had Mental andbehavioral abnormalities,12 patients(75%)had language disorder,11 patients(68.75%)had disturbance of consciousness.10 cases(62.5%)had seizures,of which 4 cases(25.00%)had status epilepticus.There were 9 cases(56.25%)with involuntary movements,5 cases(31.25%)with autonomic nervous dysfunction and 7 cases(43.75%)with central ventilation insufficiency.7 cases(43.75%)were admitted to intensive care unit because of central hypopnea or continuous state of epileptic pain.All patients received high-dose glucocorticoid therapy,of which 6 patients were treated with gamma globulin.After evaluating the poor efficacy of the patients,16 patients received 63 times of plasma exchange therapy.After plasma exchange,12 patients reduced the modified Rankin scale by at least one grade,with an effective rate of 75.00%.One patient after plasma exchange showed that the titer of anti-NMDA receptor antibody in serum changed from 1:10 to negative,and the titer of anti-NMDA receptor antibody in cerebrospinal fluid decreased from 1:32 to 1:3.2.The rest of the patients did not reexamine the anti-NMDA receptor antibody.Among the patients with negative serum anti-NMDA receptor antibody,there were 4patients whose modified Rankin scale was reduced by at least one grade after plasma exchange,with an effective rate of 80.0%.Among the patients with positive serum anti-NMDA receptor antibody,8 patients decreased the modified Rankin scale by at least one grade after plasma exchange,with an effective rate of 72.73%.There was no significant difference in the clinical efficacy of plasma exchange therapy for anti-NMDA receptor antibody negative and serum anti-NMDA receptor antibody-positive anti-NMDA receptor encephalitis(P=0.635).Of the 63 plasmapheresis treatments,4 had adverse reactions(6.35%),followed by allergic reactions(3.17%),thrombocytopenia(1.59%)and PE pipeline coagulation(1.59%).There were no serious adverse reactions to death.Conclusion In the treatment of severe anti-NMDA receptor encephalitis,plasmapheresis may be a safe and effective treatment.