| An effective immunotherapy regimen for VGKC antibody-positive limbic encephalitis. | |
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MedLine Citation:
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PMID: 20660916 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Voltage-gated potassium channel antibody-positive limbic encephalitis (VGKC+LE) frequently improves with immunotherapy, although the optimum regimen is unknown. The effectiveness of a combination immunomodulatory regimen was tested in consecutive VGKC+LE patients. METHODS: This was an open-label prospective study of nine VGKC+LE patients. All patients had plasma exchange (50 ml/kg), intravenous immunoglobulin (2 g/kg) and intravenous methylprednisolone (1 g×3), followed by maintenance oral prednisolone (1 mg/kg/day). Mycophenolate (2 g/day) was used in the first three patients. Assessments included serial clinical, cognitive, brain MRI and VGKC antibody testing. RESULTS: Within 1 week, seizures and hyponatraemia remitted in all affected patients. Cognitive function improved in all patients within 3 months. MRI appearances improved substantially within 9 months, with remission of inflammation in the majority of patients. All achieved immunological remission with normal VGKC antibody titres within 1-4 months. Major adverse events of therapy included one septicaemia and one thrombosis on plasma exchange and one death from sepsis after incidental bowel surgery. One patient remains in remission after 40 months of follow up, 26 months after being off all treatment. CONCLUSIONS: Our immunotherapy regimen was effective for the treatment of the clinical, cognitive and immunological features of VGKC+LE. Radiological improvement was seen in the majority. Pending randomised controlled trials, this regimen is proposed for the treatment of VGKC+LE. |
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Authors:
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S H Wong; M D Saunders; A J Larner; K Das; I K Hart |
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Publication Detail:
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Type: Clinical Trial; Journal Article Date: 2010-07-26 |
Journal Detail:
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Title: Journal of neurology, neurosurgery, and psychiatry Volume: 81 ISSN: 1468-330X ISO Abbreviation: J. Neurol. Neurosurg. Psychiatr. Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-27 Completed Date: 2010-10-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 2985191R Medline TA: J Neurol Neurosurg Psychiatry Country: England |
Other Details:
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Languages: eng Pagination: 1167-9 Citation Subset: IM |
Affiliation:
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Department of Neurology, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK. suiwong@doctors.org.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anti-Inflammatory Agents / administration & dosage Cognition Disorders / complications, drug therapy* Drug Therapy, Combination Female Humans Immunoglobulins / administration & dosage* Immunologic Factors / administration & dosage Immunosuppressive Agents / therapeutic use Limbic Encephalitis / complications, drug therapy*, immunology Magnetic Resonance Imaging Male Methylprednisolone / administration & dosage* Middle Aged Mycophenolic Acid / analogs & derivatives*, therapeutic use Potassium Channels, Voltage-Gated / immunology* Prednisolone / therapeutic use* Serotyping |
| Chemical | |
Reg. No./Substance:
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0/Anti-Inflammatory Agents; 0/Immunoglobulins; 0/Immunologic Factors; 0/Immunosuppressive Agents; 0/Potassium Channels, Voltage-Gated; 128794-94-5/mycophenolate mofetil; 24280-93-1/Mycophenolic Acid; 50-24-8/Prednisolone; 83-43-2/Methylprednisolone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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