Hye-Rim Shin1, Yoonhyuk Jang1, Yong-Won Shin1, Kon Chu1, Sang Kun Lee1, Soon-Tae Lee1. 1. Department of Neurology (YJ, Y-WS, KC, SKL, S-TL), Seoul National University Hospital; Department of Neurology (H-RS), Dankook University Hospital, Cheonan; and Department of Neurosurgery (Y-WS), Seoul National University Hospital, South Korea.
Abstract
OBJECTIVE: Because there is no standard treatment to control dyskinesia in anti-NMDA receptor (NMDAR) encephalitis, we analyzed the therapeutic efficacy of high-dose diazepam in dyskinesia associated with NMDAR encephalitis. METHODS: We reviewed patients with NMDAR encephalitis with dyskinesia who were admitted to Seoul National University Hospital between November 2012 and July 2018. High-dose diazepam was administered orally or via a nasogastric tube 3-6 times a day. We assessed the treatment effect by comparing dyskinesia severity between the first day of the highest dose of diazepam and one week after the treatment. RESULTS: Among 68 patients with NMDAR encephalitis during the study period, 33 patients were treated with enteral diazepam (ranging from 6 to 180 mg) to control dyskinesia, along with immunotherapy. The severity of dyskinesia improved from average grade 2.4 ± 0.6 to 1.1 ± 0.7 after 1 week of the highest dose of diazepam (mean severity change -1.4 ± 0.6, 95% confidence interval -1.2 to -1.6; p < 0.001). No patients had serious adverse events except for mild sedation. CONCLUSIONS: Dyskinesia in NMDAR encephalitis improved after treatment with enteral diazepam without significant side effects. This study suggests that enteral diazepam could be a treatment option for control dyskinesia in NMDAR encephalitis. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with dyskinesias associated with NMDAR encephalitis, enteral diazepam is effective and safe in dyskinesia control.
OBJECTIVE: Because there is no standard treatment to control dyskinesia in anti-NMDA receptor (NMDAR) encephalitis, we analyzed the therapeutic efficacy of high-dose diazepam in dyskinesia associated with NMDAR encephalitis. METHODS: We reviewed patients with NMDAR encephalitis with dyskinesia who were admitted to Seoul National University Hospital between November 2012 and July 2018. High-dose diazepam was administered orally or via a nasogastric tube 3-6 times a day. We assessed the treatment effect by comparing dyskinesia severity between the first day of the highest dose of diazepam and one week after the treatment. RESULTS: Among 68 patients with NMDAR encephalitis during the study period, 33 patients were treated with enteral diazepam (ranging from 6 to 180 mg) to control dyskinesia, along with immunotherapy. The severity of dyskinesia improved from average grade 2.4 ± 0.6 to 1.1 ± 0.7 after 1 week of the highest dose of diazepam (mean severity change -1.4 ± 0.6, 95% confidence interval -1.2 to -1.6; p < 0.001). No patients had serious adverse events except for mild sedation. CONCLUSIONS: Dyskinesia in NMDAR encephalitis improved after treatment with enteral diazepam without significant side effects. This study suggests that enteral diazepam could be a treatment option for control dyskinesia in NMDAR encephalitis. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with dyskinesias associated with NMDAR encephalitis, enteral diazepam is effective and safe in dyskinesia control.
Authors: Sarosh R Irani; Katarzyna Bera; Patrick Waters; Luigi Zuliani; Susan Maxwell; Michael S Zandi; Manuel A Friese; Ian Galea; Dimitri M Kullmann; David Beeson; Bethan Lang; Christian G Bien; Angela Vincent Journal: Brain Date: 2010-06 Impact factor: 13.501