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Anti-NMDA Encephalitis Treatment — RACP Adult Medicine MCQ

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ModerateNeurologyAnti-NMDA Encephalitis TreatmentRACP Adult Medicine

A 22-year-old woman with confirmed anti-NMDA receptor encephalitis and ovarian teratoma has undergone teratoma removal. She continues to have seizures and psychiatric symptoms 2 weeks post-surgery. She has received IV methylprednisolone and IVIG without significant improvement. What is the most appropriate next step?

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Correct answer: D — Rituximab

Anti-NMDA receptor encephalitis not responding to first-line immunotherapy (IVIG + corticosteroids) within 2 weeks warrants second-line treatment. Rituximab is the preferred second-line agent (often combined with cyclophosphamide). Early escalation to second-line improves outcomes. Recovery is often slow (months) but ~80% achieve good functional outcome. Relapses occur in ~12%.

Reference: Graus 2016; Lancet Neurol 2024 Autoimmune Encephalitis Treatment