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Updated: Mar 23, 2026
Induction and Clinical Scoring of Chronic-Relapsing Experimental Autoimmune Encephalomyelitis
Published on: July 4, 2007
Rituximab treatment for autoimmune limbic encephalitis in an institutional cohort
Woo-Jin Lee1, Soon-Tae Lee1, Jung-Ick Byun1
1From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea.
Objective:
To determine efficacy and safety of rituximab treatment as a second-line immunotherapy treatment for autoimmune limbic encephalitis (ALE) and to determine factors associated with functional improvement and favorable outcome following rituximab treatment.
Methods:
We recruited 80 patients with ALE who were treated with rituximab as a second-line immunotherapy from the Korea Autoimmune Synaptic and Paraneoplastic Encephalitis Registry and reviewed 81 patients without rituximab as a control. We grouped patients according to the detection or type of antibodies; in addition, we evaluated clinical, laboratory, first-line immunotherapy, and rituximab treatment profiles and defined main outcomes as improvements on the modified Rankin Scale (mRS) score and a favorable mRS score (0-2) at the last follow-up.
Results:
Functional improvement occurred more frequently in the rituximab group compared to the control group. In the rituximab group, 30 (37.5%) patients had synaptic autoantibodies, 15 (18.8%) in the paraneoplastic autoantibodies, and 35 (43.8%) were antibody-negative. The effect of rituximab was the same regardless of autoantibody status. Additional monthly rituximab therapy and partial response to first-line immunotherapies were associated with mRS score improvements, as well as favorable mRS scores. mRS scores of 4-6 as the worst neurologic status predicted an unfavorable mRS score. There were no reported serious infusion-related or infectious adverse effects of rituximab.
Conclusions:
Rituximab is effective and safe as a second-line immunotherapy for ALE, regardless of autoantibody status. Additional monthly rituximab therapy might potentiate the efficacy of rituximab.
Classification Of Evidence:
This study provides Class IV evidence that rituximab improves mRS scores for patients with autoimmune limbic encephalitis who fail first-line therapy.
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