RESUMEN
BACKGROUND: The correlation between detection of autoantibodies and the pattern and severity of symptoms in patients with encephalitis was the crucial factor for the initiation of immune therapy. The elimination of autoantibodies using therapeutic apheresis by plasma exchange (PE) and immunoadsorption (IA) is a pathophysiologically guided therapeutic approach. The aim was to evaluate the current use of PE and for the first time also of IA for patients with autoimmune encephalitis. METHODS: A nationwide data collection was performed and the modified Rankin score (mRS) was used to evaluate the severity of neurological symptoms. RESULTS: Data of 31 treatment courses (30 patients and 1 relapse) were documented and 22 patients were positive for autoantibodies (NMDA-R, GABA, VGKC, Hu). In 23 cases PA was performed, tryptophan IA in 7 cases and in 1 patient both methods were applied. In 67 % of the treatment courses the mRS improved and the mean mRS of all patients was 3.2 before apheresis and 2.2 after apheresis (p < 0.05). All patients who were treated with IA improved clinically from a mean mRS of 3.9 before IA to 1.9 after IA (p < 0.01). CONCLUSIONS: For immune-mediated forms of encephalitis rapid elimination of autoantibodies with PA and IA seems to be an effective therapeutic option as part of a multimodal immune therapy and is already established in many clinics in Germany.
Asunto(s)
Autoanticuerpos/aislamiento & purificación , Eliminación de Componentes Sanguíneos/métodos , Encefalopatías/epidemiología , Encefalopatías/terapia , Enfermedad de Hashimoto/epidemiología , Enfermedad de Hashimoto/terapia , Sistema de Registros , Adolescente , Adulto , Distribución por Edad , Anciano , Autoanticuerpos/inmunología , Encefalopatías/inmunología , Encefalitis , Femenino , Alemania/epidemiología , Enfermedad de Hashimoto/inmunología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Resultado del Tratamiento , Adulto JovenRESUMEN
Manual medicine-osteopathy (MMO) is of keen interest among young doctors, generalists and specialists alike. Through a discerning semiological approach, MMO allows non-pharmaceutical physical treatments to be proposed for many musculoskeletal pathologies. In March 2007, some manual therapies (e.g., osteopathy), until then the exclusive preserve of physicians, were recognized in France as a part of the field of professional expertise of non-physicians. This new opening of the manual medicine profession must make non-physicians and physicians aware of their responsibilities.