Management of autoimmune encephalitis

Autoimmune encephalitides are established diagnoses in contemporary neurology. Their management poses a regular challenge for almost all neurologists. One may ask if the concept of 1st line and 2nd line treatment is still up to date, which new data on the antibody-defined encephalitis types exist, and how to organize long-term management.

The 1st line/2nd line concept of initial immunological intervention is accepted worldwide. A randomized controlled trial confirmed that one 1st line compound (intravenous immunoglobulins) is superior to a placebo in patients with antibodies against leucine-rich glioma inactivated protein 1. Rituximab, a 2nd line compound, is increasingly and apparently successfully used in treating different types of autoimmune encephalitis. It may find its place even earlier in the treatment cascade. Long-term management needs to be improved and is under development.

There have been no groundbreaking new developments in the field. The published experience confirms existing suggestions. Aspects of long-term management including rehabilitation measures and counseling about driving eligibility require further research.