This research was supported in part by the Intramural Research Program of the National Institutes of Health, Annual report ZIA MH002922-12.. we looked at patterns by region (Southeast 4, Northeast 5, Midwest 2, West 1, and 1 unspecified). Single supplier responses were also received from Europe, the Middle East, and from South America. Table 1 International survey of AACAP Autoimmune Encephalitis Special Interest Group Users. = 20 /th th valign=”top” align=”center” rowspan=”1″ colspan=”1″ US Southeast (4) /th th valign=”top” align=”center” rowspan=”1″ colspan=”1″ US Northeast (5) /th th valign=”top” align=”center” rowspan=”1″ colspan=”1″ US Midwest (2) /th th valign=”top” align=”center” rowspan=”1″ colspan=”1″ US West (1) /th th valign=”top” align=”center” rowspan=”1″ colspan=”1″ US Unspecified (1) /th th valign=”top” align=”center” rowspan=”1″ colspan=”1″ Canada (4) /th th valign=”top” align=”center” rowspan=”1″ colspan=”1″ Europe (1) /th th valign=”top” align=”center” rowspan=”1″ colspan=”1″ Middle East (1) /th th valign=”top” align=”center” rowspan=”1″ colspan=”1″ South America (1) /th /thead MRI100100100100100100100100100Ultrasound10010010010010075100100100PET75801001001005010000VEEG1001001001001001001001000LP100100100100100100100100100Peds Rheum10060100100100100100100100Peds Neuro100100100100100100100100100Peds Crit Care100100100100100100100100100Peds ID100801001001001001001000IVIG1001001001001001001001000IV Steroids100100100100100100100100100Plasmapheresis100801001001001001001000RTX1001001001001001001001000TCZ50100100100100501001000ECT Adolescent Yes/Maybe/No75/0/2580/20/050/0/500/100/00/0/10050/50/0100/0/00/0/100100/0/0ECT Child Yes/Maybe/No25/25/5040/20/4050/0/500/0/1000/0/10050/25/250/0/1000/0/100100/0/0 Open in a separate windows em AACAP, American Academy of Child and Adolescent Psychiatry; ECT, electroconvulsive therapy; IV, intravenous; IVIG, intravenous immunoglobulins; LP, lumbar puncture; MRI, magnetic resonance imaging; Peds Crit Care, pediatric critical care; Peds ID, pediatric infectious disease; Peds Neuro, pediatric neurology; Peds Rheum, pediatric rheumatology; PET, positron emission tomography; RTX, rituximab; TCZ, tocilizumab; US, United States; VEEG, video electroencephalogram /em . Diagnostic resources were relatively consistent with the main variability being in Positron Emission Tomography (PET) available to only 14/20 (70%) of programs despite an increased interest in the use of this modality for diagnostic clarification as noted above (19). Only one program reported lack of access to video EEG (South America) and all providers indicated that it was possible to facilitate a lumbar puncture RU-301 (LP). Specialist availability was 100% for pediatric neurology, but only 60 and Fosl1 80% of the northeastern US responders reported respective access to pediatric rheumatology (three says) and infectious disease (four says). South America reported absence of infectious disease RU-301 consultants. Treatment availability varied. All programs reported access to IV steroids. All US, Canadian, and European programs reported access to IVIG but one program (South America) reported no access to IVIG. All except South America have access to Rituximab while Tocilizumab is usually less consistently available (unavailable in two of the southeastern says, two Canadian programs, and not available in South America). Plasmapheresis was reported as available to all programs except one northeastern state and South America. Electroconvulsive therapy (ECT) is the most inconsistently available treatment RU-301 both for child patients as well as adolescent patients. This is important to acknowledge given that malignant catatonia may be responsive to treatment yet can be fatal if unrecognized and/or untreated (14C16, 21). Here we spotlight a sampling of current treatment models across the globe (see Physique 1): Open in a separate window Physique 1 A comparison of program specific assessment and treatment pathways for AE. AE, autoimmune encephalitis; AZA, azathioprine; CSF, cerebral spinal fluid; CYC, cyclophosphamide; ECT, electroconvulsive therapy; EEG, electroencephalogram; ICU, rigorous care unit; IV, intravenous methylpredinisone; IVIG, intravenous immunoglobulins; MRI, magnetic resonance imaging; MYC, mycophenolate mofetil; NMDA, N-methyl-D-asparate; PX, plasmapheresis; PET, positron emission tomography; RTX, rituximab. A Canadian Treatment Model The Canadian model varies across institutions with most AE cases managed by neurology or pediatrics and supported by specialist psychiatrists. We describe one model of tertiary care in Edmonton, Alberta. Patients with severe psychiatric symptoms, early unfavorable investigations, and minimal neurological findings or seizures are managed around the psychiatric unit with discussion support by neurology and other subspecialties. Atypical clinical features suspicious for AE, such as subacute onset of either working memory deficits, altered mental status, a new focal neurological obtaining or seizure would trigger an AE work up once RU-301 option causes had been reasonably excluded. Initial work up includes serum studies, urine studies, a respiratory viral panel, serial EEG, and MRI brain. Lumbar Punctures are obtained by anesthesiology in the ECT suite. Standardized rating scales, such as the Montreal Cognitive Assessment and the Bush Francis for catatonia are utilized and repeated throughout the duration of a patient’s hospitalization. The.
This research was supported in part by the Intramural Research Program of the National Institutes of Health, Annual report ZIA MH002922-12