文獻類型
Review
DOI
10.4414/smw.2020.20377
Related to 立于の專案項目庫（P） (醫學文獻)
完成閱讀
Related to 立于の專案項目庫（P） (醫學文獻) 1
結論
Related to 立于の專案項目庫（P） (Property)
Abstract
Background: aimed to review case reports and to provide recommendations for the management of ICI-associated encephalitis.
Methods: A literature search using Google Scholar and PubMed was performed in December 2019. Published case reports and case series of ICI-associated encephalitis were reviewed, and a case series from the Limmattal Hospital in Schlieren, Switzerland was added. The results are presented as numbers and medians (ranges).
Results:
- Five different ICIs caused encephalitis in the 47 patients included in this case series. Nivolumab was the most frequently involved drug (27/47, 57%).
- The
median timebetween treatment and onset of symptoms: 65 (4-630) days.
- Symptoms: rapidly evolving confusion, reduced level of consciousness, headache, seizures and focal neurological deficits (e.g., motor deficits, paraesthesia, aphasia or ataxia).
- Examination:
- 19/44 (43%) MRI scans performed revealed findings suggestive of encephalitis.
- No specific EEG pattern consistent with encephalitis was found, but epileptiform discharges were detected in 7/20 (35%) of all tested patients.
- Typical findings of cerebrospinal fluid (CSF) analysis were pleocytosis, elevated protein levels and normal glucose concentrations.
- Management:
- 44 out of 47 (94%) patients received corticosteroids. Typically, “high” (>30 mg) and “very high” (>100 mg) daily corticosteroid doses were used. The mean (range) dose was 997 (24–12,000) mg methylprednisolone, IV 5 days then shift to po and taper
- IVIG, rituximab and plasma exchange therapy were less frequently prescribed. Nine out of 47 (19%) patients died during the index hospitalisation.
Conclusions: Encephalitis should be suspected in patients treated with ICIs who present with rapidly evolving confusion. Blood tests, CSF analysis, cerebral MRI and an EEG should be performed. Therapy with intravenous corticosteroids is recommended. Steroid unresponsiveness is rare and should lead to a review of the diagnosis. Alternative treatment options are IVIG, plasma exchange therapy and rituximab.  .