Table 1 Immunotherapy used in anti-NMDA receptor encephalitis

High-dose corticosteroids (methylprednisolone)

30 mg/kg (max 1000 mg, divided into 1–2 doses) for 3–5 days

IV

Reduce inflammation and promote anti-inflammatory effects

[34, 57, 58]

IVIg

2 g/kg over 3–5 days (400 mg/kg/day)

IV

produce anti-inflammatory and immunomodulatory effects through multidirectional pathways, such as autoantibody neutralization, decreasing seizure frequency in glioma-inactivated 1 (LGI1), and contactin-associated protein-like 2 (CASPR2) encephalitis

[34, 61, 89]

PLEX

5–7 cycles of 1 session every other day

IV

eliminates autoantibodies and other pathogenic chemicals from plasma, as well as altering the immune system by changing lymphocyte numbers and distribution, T-suppressor cell activity, and T-helper cell phenotypes

[34, 61]

Rituximab

375 mg/m² (max 1000 mg) for 4 weeks

IV

eliminates antibody-producing plasma cells, reducing circulating anti-NMDA receptor antibody levels

[34, 90]

Cyclophosphamide

Monthly pulses of 500–1000 mg/m² (max 1500 mg) for 3–6 months

IV

has a high bioavailability in the central nervous system (CNS) and can cause local immunomodulation and immunosuppression

[34, 61]

Tocilizumab

12 mg/kg (if < 30 kg) or 8 mg/kg (if ≥ 30 kg), (max 800 mg) given monthly for at least 6 months or more

IV

Suppressing the effects of pro-inflammatory cytokine (IL-6) and antibodies by long-lived plasma cells, inducing better therapeutic effects in patients

[21, 34, 61]