IV line Treatment

Initial Treatment in Patients with AIE

The Canadian guidelines based recommended treatment algorithm

Reference: Hahn C, Budhram A, Alikhani K, et al.Canadian Consensus Guidelines for the Diagnosis and Treatment of Autoimmune Encephalitis in Adults. Can J Neurol Sci.Published online February 5, 2024. doi:10.1017/cjn.2024.16

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Checklist

Clinical Tips

- First-line therapy includes initiation of: 1. High dose steroids and IVIG  OR  2. High dose steroids and Plasma exchange. (In the absence of contraindications)

 

- Completion of neural antibody testing and CSF examination are strongly recommended before starting IVIG since IVIG treatment can affect autoantibody testing results and can cause CSF pleocytosis. 

 

- IVIg can result in false-positive Hepatitis B core antibody results leading to unnecessary use of anti-viral medications. Therefore, completion of the recommended infectious work up should be completed prior to IVIG administration. 

 

AIE Classification

Steroid Monotherapy

Steroid monotherapy can be considered in mild/ moderate cases

pills

Steroid Taper

"It is recommended to consider a corticosteroid taper in most patients treated with any first-line treatment protocol that includes high-dose intravenous (IV) steroids, especially in patients with severe disease, provided there are no medical contraindications

 

Click below for information about steroid taper in patients with AIE to access the Canadian Consensus Guidelines for the Diagnosis and Treatment of Autoimmune Encephalitis in Adults

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Caution

Treatment in Patients Meeting only Possible AIE Criteria

"In​ cases where criteria are met only for “possible” AIE after investigations including neural antibody testing are complete, early involvement of a specialist in autoimmune neurology is important. This is especially true if considering a trial of immunotherapy" 

 

Reference: Hahn C, Budhram A, Alikhani K, et al. Canadian Consensus Guidelines for the Diagnosis and Treatment of Autoimmune Encephalitis in Adults. Can J Neurol Sci. Published online February 5, 2024. doi:10.1017/cjn.2024.16

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