TY - JOUR
T1 - Refractory Anti-NMDA Receptor Encephalitis in Early Pregnancy
T2 - A Case Report of Treatment Course and Pregnancy Outcomes
AU - Fredrich, Sarah
AU - Wang, Cynthia
AU - Narayan, Ram
AU - Tardo, Lauren
AU - Blackburn, Kyle M.
AU - Vernino, Steven
N1 - Funding Information:
S. Fredrich's fellowship was funded by the National Multiple Sclerosis Society. She has served as a consultant to EMD Serono. C. Wang and R. Narayan report no disclosures. L. Tardo's fellowship was funded by the National MS Society. K. Blackburn's fellowship was funded by the Siegel Rare Neuroimmune Association. S. Vernino has served as a consultant to Alterity, Genentech, Catalyst and Sage Therapeutics. He has received research support from Dysautonomia International, BioHaven, Grifols, and Quest Diagnostics (through a licensing contract). Go to Neurology.org/NN for full disclosures.
Publisher Copyright:
Copyright © 2020 American Academy of Neurology.
PY - 2022/9/20
Y1 - 2022/9/20
N2 - Background and Objectives: Anti-N-methyl d-aspartate receptor (NMDAR) encephalitis classically affects women of childbearing age, producing a disproportionate number of pregnant women with anti-NMDAR encephalitis. The typical presentation includes progressive neuropsychiatric symptoms, seizures, and alterations in consciousness, all of which present potential risks to the fetus. First-line and second-line treatments similarly pose teratogenic potential; therefore, randomized studies with supportive data on pregnancy and fetal outcomes are lacking. Methods We present a case of refractory anti-NMDAR encephalitis during the first and second trimesters of pregnancy with the successful use of rituximab and cyclophosphamide and resultant healthy pregnancy. Results The patient was treated with an escalating immunotherapy regimen from 11 to 15 weeks of gestation, including steroids, plasma exchange, IV immunoglobulins, and rituximab, with no clinical response. At 16 weeks of gestation, she received cyclophosphamide with clinical improvement after 4 weeks. She subsequently gave birth to a healthy, term baby boy, who continued to do well at the follow-up. Discussion : This case illustrates the effective use of cyclophosphamide in the second trimester of pregnancy for anti-NMDAR encephalitis. The use of second-line therapies remains an individualized decision because the relative risk-to-benefit ratio in pregnant women is incompletely understood.
AB - Background and Objectives: Anti-N-methyl d-aspartate receptor (NMDAR) encephalitis classically affects women of childbearing age, producing a disproportionate number of pregnant women with anti-NMDAR encephalitis. The typical presentation includes progressive neuropsychiatric symptoms, seizures, and alterations in consciousness, all of which present potential risks to the fetus. First-line and second-line treatments similarly pose teratogenic potential; therefore, randomized studies with supportive data on pregnancy and fetal outcomes are lacking. Methods We present a case of refractory anti-NMDAR encephalitis during the first and second trimesters of pregnancy with the successful use of rituximab and cyclophosphamide and resultant healthy pregnancy. Results The patient was treated with an escalating immunotherapy regimen from 11 to 15 weeks of gestation, including steroids, plasma exchange, IV immunoglobulins, and rituximab, with no clinical response. At 16 weeks of gestation, she received cyclophosphamide with clinical improvement after 4 weeks. She subsequently gave birth to a healthy, term baby boy, who continued to do well at the follow-up. Discussion : This case illustrates the effective use of cyclophosphamide in the second trimester of pregnancy for anti-NMDAR encephalitis. The use of second-line therapies remains an individualized decision because the relative risk-to-benefit ratio in pregnant women is incompletely understood.
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U2 - 10.1212/NXI.0000000000200007
DO - 10.1212/NXI.0000000000200007
M3 - Article
C2 - 35728968
AN - SCOPUS:85132314078
SN - 2332-7812
VL - 9
JO - Neurology: Neuroimmunology and NeuroInflammation
JF - Neurology: Neuroimmunology and NeuroInflammation
IS - 5
M1 - e200007
ER -