{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:06:10Z","timestamp":1790661970195,"version":"4.1.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T00:00:00Z","timestamp":1607904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013318","name":"ShanXi Science and Technology Department","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013318","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p><jats:bold>Purpose:<\/jats:bold> To assess the efficacy and safety of rituximab treatment as second-line immunotherapy in pediatric cases of anti-NMDA receptor (NMDAR) encephalitis.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We retrospectively recruited 8 patients with anti-NMDAR encephalitis who were treated with rituximab as second-line immunotherapy. We evaluated the clinical features, laboratory examination results and treatment protocols of the Chinese children and defined good outcomes based on the modified Rankin scale (mRS) score (0\u20132) at the last follow-up.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> A total of eight pediatric patients (median age 6.7 years; four female) with refractory anti-NMDAR encephalitis were recruited to the study. Rituximab was given after a median duration of disease of 57 days (range 50.5\u2013113.75 days). The use of rituximab led to a significant reduction in the mRS and CD19+ B-cells compared to before rituximab infusion (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). Five patients (62.5%) had a good outcome (mRS \u2264 2) including four patients (50%) who showed complete recovery (mRS = 0) at the last follow-up. Transient infusion adverse events were recorded in 2 patients (25%). Two patients (25%) had severe infectious adverse events (AEs) and two patients with grade 5 (death). None of the patients developed progressive multifocal leukoencephalopathy (PML).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Our study provides evidence that rituximab can efficiently improve the clinical symptoms of anti-NMDAR encephalitis in children. However, due to the risk of adverse infections, rituximab should be restricted in pediatric patients with high rates of mortality and disability.<\/jats:p>","DOI":"10.3389\/fneur.2020.606923","type":"journal-article","created":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T05:32:53Z","timestamp":1607923973000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["Efficacy and Safety of Rituximab in Chinese Children With Refractory Anti-NMDAR Encephalitis"],"prefix":"10.3389","volume":"11","author":[{"given":"Xiangjun","family":"Dou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongjing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2020,12,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/S1474-4422(10)70253-2","article-title":"Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis","volume":"10","author":"Dalmau","year":"2011","journal-title":"Lancet Neurol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1212\/WNL.0000000000000570","article-title":"Utility and safety of rituximab in pediatric autoimmune and inflammatory CNS disease","volume":"83","author":"Dale","year":"2014","journal-title":"Neurology."},{"key":"B3","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1002\/ana.21756","article-title":"Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents","volume":"66","author":"Florance","year":"2009","journal-title":"Ann Neurol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"157","DOI":"10.3988\/jcn.2014.10.2.157","article-title":"Anti-N-methyl-D-aspartate receptor encephalitis in Korea: clinical features, treatment, and outcome","volume":"10","author":"Lim","year":"2014","journal-title":"J Clin Neurol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1111\/ene.12911","article-title":"Anti-NMDA receptor encephalitis: clinical characteristics, predictors of outcome and the knowledge gap in southwest China","volume":"23","author":"Wang","year":"2016","journal-title":"Eur J Neurol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.3892\/etm.2018.6329","article-title":"Clinical diagnosis and treatment of pediatric anti-n-methyl-d-aspartate receptor encephalitis: a single center retrospective study","volume":"16","author":"Sai","year":"2018","journal-title":"Exp Ther Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fneur.2019.00906","article-title":"Pediatric autoimmune encephalitis: case series from two chinese tertiary pediatric neurology centers","volume":"10","author":"Zhang","year":"2019","journal-title":"Front Neurol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.pedneo.2018.10.006","article-title":"Immunotherapy for anti-NMDA receptor encephalitis: experience from a single center in Taiwan","volume":"60","author":"Kong","year":"2019","journal-title":"Pediatr Neonatol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/S1474-4422(12)70310-1","article-title":"Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study","volume":"12","author":"Titulaer","year":"2013","journal-title":"Lancet Neurol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1007\/s00415-015-7781-9","article-title":"Treatment and outcome of children and adolescents with N-methyl-d-aspartate receptor encephalitis","volume":"262","author":"Zekeridou","year":"2015","journal-title":"J Neurol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"118","DOI":"10.5863\/1551-6776-22.2.118","article-title":"Rituximab for treatment of refractory anti-NMDA receptor encephalitis in a pediatric patient","volume":"22","author":"Hallowell","year":"2017","journal-title":"J Pediatr Pharmacol Ther."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1212\/WNL.0000000000002635","article-title":"Rituximab treatment for autoimmune limbic encephalitis in an institutional cohort","volume":"86","author":"Lee","year":"2016","journal-title":"Neurology."},{"key":"B13","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.jns.2017.04.007","article-title":"Lower dosages of rituximab used successfully in the treatment of anti-NMDA receptor encephalitis without tumour","volume":"377","author":"Wang","year":"2017","journal-title":"J Neurol Sci"},{"key":"B14","unstructured":""},{"key":"B15","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.ejpn.2015.02.006","article-title":"Paediatric anti-N-methyl-d-aspartate receptor encephalitis: the first Italian multicenter case series","volume":"19","author":"Sartori","year":"2015","journal-title":"Eur J Paediatr Neurol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fneur.2019.00596","article-title":"Clinical features, treatment, and outcomes among Chinese children with anti-methyl-d-aspartate receptor (Anti-NMDAR) encephalitis","volume":"10","author":"Zhang","year":"2019","journal-title":"Front Neurol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.ejpn.2016.11.016","article-title":"Epileptic phenotypes, electroclinical features and clinical characteristics in 17 children with anti-NMDAR encephalitis","volume":"21","author":"Haberlandt","year":"2017","journal-title":"Eur J Paediatr Neurol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jneuroim.2017.09.005","article-title":"Anti-N-methyl-D-aspartate receptor encephalitis in children of Central South China: Clinical features, treatment, influencing factors, and outcomes","volume":"312","author":"Wang","year":"2017","journal-title":"J Neuroimmunol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.jneuroim.2019.02.008","article-title":"Reduced dosage rituximab in the treatment of anti-N-methyl-D-aspartate receptor encephalitis: an observation study in Chinese patients","volume":"330","author":"Deng","year":"2019","journal-title":"J Neuroimmunol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.pediatrneurol.2018.07.006","article-title":"Low-dose rituximab in children with anti-NMDAR encephalitis","volume":"87","author":"Dhawan","year":"2018","journal-title":"Pediatr Neurol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.pediatrneurol.2018.05.003","article-title":"Evaluation of responsiveness to reduced-dose rituximab in corticotropin\/intravenous immunoglobulin\/rituximab combination immunotherapy for opsoclonus-myoclonus syndrome","volume":"85","author":"Pranzatelli","year":"2018","journal-title":"Pediatr Neurol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1177\/0883073820923834","article-title":"Autoimmune encephalitis in children: a case series at a tertiary care center","volume":"35","author":"Rutatangwa","year":"2020","journal-title":"J Child Neurol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.2169\/internalmedicine.51.6874","article-title":"Rituximab used successfully in the treatment of anti-NMDA receptor encephalitis","volume":"51","author":"Ikeguchi","year":"2012","journal-title":"Intern Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1111\/ane.13291","article-title":"Efficacy and safety of rituximab in autoimmune encephalitis: a meta-analysis","volume":"142","author":"Nepal","year":"2020","journal-title":"Acta Neurol Scand"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1001\/jamaneurol.2013.3071","article-title":"A 5-year follow-up of rituximab treatment in patients with neuromyelitis optica spectrum disorder","volume":"70","author":"Kim","year":"2013","journal-title":"JAMA Neurol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1212\/WNL.0b013e3182152881","article-title":"Long-term follow-up of patients with neuromyelitis optica treated with rituximab","volume":"76","author":"K\u00fcmpfel","year":"2011","journal-title":"Neurology."},{"key":"B27","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1212\/WNL.0b013e3182a1aac7","article-title":"Responsiveness to reduced dosage of rituximab in Chinese patients with neuromyelitis optica","volume":"81","author":"Yang","year":"2013","journal-title":"Neurology."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2020.606923\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T05:32:56Z","timestamp":1607923976000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2020.606923\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,14]]},"references-count":27,"alternative-id":["10.3389\/fneur.2020.606923"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2020.606923","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,14]]},"article-number":"606923"}}