KẾT QUẢ ĐIỀU TRỊ CỦA CORTICOSTEROID TRONG BỆNH LÝ VIÊM NÃO TỰ MIỄN DO KHÁNG THỂ KHÁNG THỤ THỂ N-METHYL-D-ASPARTATE TẠI TRUNG TÂM THẦN KINH BỆNH VIỆN BẠCH MAI

Abstract

Objective: To assess the outcomes of corticosteroid treatment in autoimmune encephalitis with N-methyl-D-aspartate receptor antibodies (anti-NMDAR encephalitis). Subjects: 40 patients diagnosed and treated for anti-NMDAR encephalitis between 01/2020 and 11/2022 at the Neurology Center of Bach Mai Hospital. Methods: Cross-sectional descriptive study. In this study, patients with anti-NMDAR encephalitis were initially treated with corticosteroid monotherapy followed by combination with plasma exchange and/or second-line immunotherapy consisting of rituximab or cyclophosphamide in case of non-response to corticosteroid treatment. Patients with a modified Rankin Scale (mRS) score of ≤ 2 at discharge were classified as good treatment outcome, and patients with a modified Rankin Scale (mRS) score of > 2 at discharge were classified as poor treatment outcome. We then evaluated the result of corticosteroid therapy. Results: Among the 40 study patients, we observed that the majority of patients were female (72.5%), with a male-to-female ratio of 1/2.64 and a mean age of 33.25 ± 15.01 years. All patients received immunotherapy, with 16 patients (40%) receiving corticosteroid monotherapy and 24 patients (60%) receiving corticosteroid in combination with other immunotherapies. The treatment outcomes at discharge were equivalent, with 19 patients (47.5%) having good outcomes and 21 patients (52.5%) having poor outcomes. 87.5% of patients who showed a good response to corticosteroid monotherapy achieved good treatment outcome while only 20.8% of patients who failed to respond to corticosteroid monotherapy acquired similar result. Of the 16 patients treated with corticosteroid monotherapy, 11 were female (68.75%) and 5 were male (31.25%). The rate of good and poor treatment outcomes in the female group was 90.9% and 9.1%, respectively, while in the male group it was 60% and 40%, with no significant difference in the treatment outcomes between males and females in the corticosteroid monotherapy group (p-value = 0.214). Conclusion: Out of 40 patients in this cross-sectional descriptive study, 47.5% achieved a favorable treatment outcome while 52.5% did not. Good treatment outcome was acquired by 87.5% of patients who responded well to corticosteroid monotherapy and only 20.8% of patients who were not responded to corticosteroid monotherapy.