Annals of Indian Academy of Neurology
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Intrathecal rituximab as a rescue therapy in refractory pure CSF positive, Non-Teratomatous type anti-NMDAR encephalitis

 Department of Neurology, Indo American Hospital Institute of Brain and Spine, Vaikom, Kerala, India

Correspondence Address:
Kurian Thomas,
Consultant Neurologist, Department of Neurology, Indo American Hospital Institute of Brain and Spine, Chemmanakary, Vaikom, Kottayam - 686 143, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.aian_134_22

NMDAR antibody encephalitis is the most common autoimmune encephalitis characterized by a myriad of neuropsychiatric symptoms. It predominantly affects females and is associated with ovarian teratoma (58%). Nineteen percent do not respond to treatment and are left with serious neurological deficits. A subset of NMDAR encephalitis with antibody positivity in CSF alone without ovarian teratoma is often found to be refractory to treatment. We name them Pure CSF positive, non-teratomatous type anti-NMDAR encephalitis. We report two such cases who responded to intrathecal rituximab, to highlight a novel treatment as a rescue therapy to prevent long-term disability and improve clinical outcomes.

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