Rituximab Injection: A Case Study

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Both of the presented patients had positive response to therapy after Rituximab injection as their MMSE increased remarkably. Also Rituximab has decreased FBDS episodes. Moreover, It should be noted that psychotic symptoms in the second patient were also resolved following Rituximab injection. Both patients satisfactorily tolerated Rituximab and had no side effects after injection. In summery this two case reports were successful examples of the treatment of LE with Rituximab.
The exact mechanism of Rituximab in LGI1 patients is still unclear. One possible explanation is that Rituximab targets CD20 on B cells, so it can attenuate B cells and deplete antibodies.[19]
As an increasing number of autoimmune non-paraneoplastic encephalitis cases
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Bases on Finke and colleagues [22] in the long term, LGI1 associated LE will cause structural damage in the hippocampal system and produces various degrees of cognitive impairment.[22] Hence rapid diagnosis and early effective treatment is warranted to decrease long term brain damages. Considering good prognosis after immunotherapy, neurologists should be vigilant about the possibility of LE when a rapidly progressive cognitive disorder is associated with epileptic seizure.[10]
Rituximab is considered to be effective and safe second line treatment for autoimmune encephalitis. Rituximab administration can be initiated in clinically diagnosed Autoimmune encephalitis regardless of autoantibody status when the response to the first line immunotherapies is insufficient. [5]
According to lee et al [5] the effects of Rituximab in the autoimmune and the paraneoplastic LE were comparable. Rituximab targets B cells and T cells are spared, so innate immune system is still working and the rate of infection will be low.[18] Rituximab has advantage of safety in cases of disturbed immune system and simultaneous infections. [23] Given the substantial efficacy and safety, in the future Rituximab might be even considered as a first line therapy for Autoimmune encephalitis.[5] Further studies are necessary to evaluate the efficacy of Rituximab as a first-line
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