Effectiveness of intra-thecal methotrexate in refractory Anti-N-methyl-d-aspartate receptor encephalitis

BMC Neurology

Table 1 Clinical Presentation of Six patients with Refractory Anti-NMDA Receptor Autoimmune Encephalitis

Case	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6
Age at onset	2 years	2 years	20 months	4 years	9 years	8 years
Gender	Female	Male	Female	Male	Male	Male
Initial symptoms	Fever	Fever	Fever	Seizure	Behavioral changes	Behavioral changes
Seizures	Focal unaware seizure	Focal unaware seizure	Focal unaware seizure	Focal unaware seizure	Focal unaware seizure	Focal unaware seizure
Seizure control	Yes	No	Yes	Yes	Yes	Yes
Psychiatric symptoms	Yes	Yes	Yes	Yes	Yes	Yes
Movement disorders	Yes	Yes	Yes	Yes	Yes	Yes
Time from onset to encephalopathy	7 days	4 days	2 days	20 days	21 days	6 days
Viral etiology	HHV6	Rhinovirus	HSV1	None	None	None
Initial EEG	Diffuse slowing	Diffuse slowing	Diffuse slowing	Diffuse slowing and bitemporal discharges	Diffuse slowing	Diffuse slowing
MRI brain	*	Normal	**	Mild brain volume loss	Normal	Normal
CSF
WBC	110	9	41	1	23	14
Protein	Normal	Normal	Normal	Normal	Normal	Normal
Initial NMDA titer	1:640	1:640	1:81	1:128	1:128	1:160
NMDA titer post IT-MTX	1:640	1:640	1:1	Not repeated	1:10	Not done
Antiviral treatment	Yes “Gancyclovir”	No	Yes “Acyclovir”	No	No	No
Duration prior to initiation of IT-MTX	13 months	6 months	42 months	6 months	5 months	8 months
Initial intensive care unit admission	7 days	8 days	7 days	11 days	7 days	73 days
Total length of admission	32 months	15 months	6 years	14 months	2 months	6 months

* High FLAIR signal in the bilateral medial and posterior thalami, bilateral frontal and parietal cortex
** Atrophy and encephalomalacia involving temporal, inferior frontal and limbic system bilaterally, more on the right side.

ISSN: 1471-2377