Antibody-mediated inflammatory brain disease (treatment)AAntibody-mediated inflammatory brain disease (treatment)Antibody-mediated inflammatory brain disease (treatment)EnglishImmunologyChild (0-12 years);Teen (13-18 years)BrainImmune systemDrug treatmentCaregivers Adult (19+)NA2013-05-13T04:00:00Z​Susanne Benseler, MD;Manisha Sickand, MSc;Marinka Twilt, MD11.000000000000043.0000000000000789.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Antibody-mediated inflammatory brain disease is treated with medications to control active inflammation and eliminate disease-causing antibodies.</p><h2>Treatment of antibody-mediated inflammatory brain disease</h2> <p>The primary treatment goals in <a href="/Article?contentid=927&language=English">antibody-mediated inflammatory brain disease</a> are to:</p> <ol> <li>Control active <a href="/Article?contentid=926&language=English">inflammation</a> </li> <li>Reduce and ultimately eliminate disease-causing antibodies</li> </ol> <p>Various treatments can be used to achieve these goals. However, the following comprise the mainstay of current treatment.</p><h2>Key points</h2> <ul> <li>Treatment goals for antibody-mediated inflammatory brain disease include controlling active inflammation and eliminating disease-causing antibodies.</li> <li>Treatment may include prednisone, rituximab, intravenous immunoglobulin and plasmapheresis.</li> <li>It is important that you ensure your child's immunizations are up-to-date because treatment can suppress the immune system. However, while on treatment, your child should not take any live vaccines.</li> </ul><h2>Treatment using prednisone</h2> <p><a href="/Article?contentid=221&language=English">Prednisone</a> is a steroid drug that inhibits various immune cells in the body. As a result, it plays a crucial role in preventing the inflammation associated with antibody-mediated reactions. Prednisone is usually one of the first-line medications when doctors believe the immune system is involved in your child's symptoms. Prednisone is given for a long time as this allows the immune system to reset itself and produce a new set of immune cells that do not attack your own proteins. Your physician will gradually reduce the prednisone dose, it is very important that you adhere to this regimen so that your body can properly adjust to the changes. </p> <p>Unfortunately, prednisone does have various unpleasant side effects; the main ones are listed below: </p> <ul> <li>Weight gain, especially in the cheeks and belly </li> <li>Hair growth, stretch marks, acne </li> <li>High blood pressure, high blood sugar, decreased bone health </li> <li>Higher risk of infection </li> </ul> <p>The good news is that many side effects are reversible and they tend to reduce in severity as the dose is lowered.</p> <h2>Treatment using rituximab</h2> <p><a href="/Article?contentid=233&language=English">Rituximab</a> is a biologic agent that targets your B cells. Remember, your B cells are the immune cells responsible for producing antibodies. Rituximab works by depleting your body's B cells and in doing so, also inhibits the production of auto-antibodies that are causing inflammation in the brain. The old B cells are eventually replaced by a new, healthy population of B cells. </p> <p>Rituximab is administered intravenously in the hospital over the course of several hours, also known as an infusion. Rituximab can be accompanied by some side effects during the infusion or shortly thereafter. Other side effects your child may experience while taking rituximab include: </p> <ul> <li>Tiredness </li> <li>Muscle stiffness </li> <li><a href="/Article?contentid=30&language=English">Fever</a>, chills</li> <li>Higher risk of infection </li> </ul> <h2>Treatment using intravenous immunoglobulin</h2> <p><a href="/Article?contentid=161&language=English">Intravenous immunoglobulin (IVIG)</a> is an intravenously administered blood product that consists of pooled antibodies from hundreds of blood donors. IVIG is effective in two particular situations:</p> <ol> <li>When the immune system attacks the body's own proteins, as we see in antibody-mediated inflammatory conditions.</li> <li>When the immune system is suppressed or inhibited. This occurs in patients who have very low white blood cell counts. </li> </ol> <p>The donor antibodies work to treat antibody-mediated disease by binding to the abnormal autoantibody and stimulating its removal. In addition, since IVIG is comprised of hundreds of donor antibodies, it also helps to boost the immune system by performing the same function as your body's native antibodies. </p> <p>IVIG is very well tolerated. Infusion reactions are possible, but can be reduced or stopped by altering the rate at which the infusion occurs.</p> <h2>Treatment using plasmapheresis</h2> <p>Plasmapheresis is a procedure that is reserved for patients who are very sick. Plasmapheresis is a blood purification procedure used most often in patients with autoimmune conditions. The procedure involves the removal of blood through a catheter placed in a patients' vein. The blood is filtered so that the liquid portion called plasma, is separated from the cellular portion that contains all the red and white blood cells. The plasma is removed , replaced and transfused back into the patient. Antibodies circulate in the plasma. Plasmapheresis works because it clears the plasma of all the circulating antibodies thought to be causing inflammation in the body. </p>
Maladie inflammatoire du cerveau liée à la présence d’anticorps (traitement)MMaladie inflammatoire du cerveau liée à la présence d’anticorps (traitement)Antibody-mediated inflammatory brain disease (treatment)FrenchImmunologyChild (0-12 years);Teen (13-18 years)BrainImmune systemDrug treatmentCaregivers Adult (19+)NA2013-05-13T04:00:00Z​Susanne Benseler, MD;Manisha Sickand, MSc;Marinka Twilt, MD11.000000000000043.0000000000000789.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Les maladies inflammatoires du cerveau liées à la présence d’anticorps sont traitées à l’aide de médicaments pour contrôler l’inflammation active et éliminer les anticorps qui provoquent la maladie.</p><h2>Le traitement de la maladie inflammatoire du cerveau liée à la présence d’anticorps</h2> <p>Le traitement de la maladie inflammatoire du cerveau liée à la présence d’anticorps <a href="/Article?contentid=927&language=French">maladie inflammatoire du cerveau liée à la présence d’anticorps</a> sont :</p> <ol> <li>La maîtrise de l’inflammation active</li> <li>La réduction et, en définitive, l’élimination des anticorps pathogènes</li> </ol> <p>Différents traitements peuvent être mis en œuvre pour atteindre ces objectifs. Pour l’essentiel, ceux administrés à l’heure actuelle sont toutefois les suivants :</p><h2>À retenir</h2> <ul> <li>Le traitement de la maladie inflammatoire du cerveau liée à la présence d’anticorps vise à contrôler l’inflammation active et à éliminer les anticorps qui provoquent la maladie.</li> <li> Le traitement peut comprendre la prednisone, le rituximab, l’immunoglobuline intraveineuse et la plasmaphérèse.</li> <li>Il est important de vous assurer que le dossier de vaccination de votre enfant soit à jour parce que le traitement peut inhiber le système immunitaire. Cependant, votre enfant ne devrait pas prendre de vaccins vivants pendant le traitement.</li> </ul><h2>​Traitement par prednisone</h2> <p>La <a href="/Article?contentid=221&language=French">prednisone</a> est un stéroïde qui inhibe différentes cellules immunitaires dans l’organisme. Par conséquent, elle joue un rôle essentiel dans la prévention de l’inflammation associée aux réactions liées à la présence d’anticorps. En général, la prednisone est un des médicaments de première intention quand les médecins croient que le système immunitaire joue un ​rôle dans les symptômes d’un enfant. La prednisone est administrée pendant une longue période pour permettre au système immunitaire de se réinitialiser et de produire de nouvelles cellules immunitaires qui n’attaquent pas les protéines du patient. Votre médecin réduira progressivement la dose de prednisone. Le respect de ce schéma posologique est très important pour que l’organisme puisse s’adapter correctement aux changements.</p> <p>Malheureusement, la prednisone a plusieurs effets secondaires désagréables, dont voici les principaux : </p> <ul> <li>Prise de poids, en particulier aux joues et au ventre</li> <li>Augmentation de la pilosité, vergetures, acné</li> <li>Hypertension, hyperglycémie, dégradation de la santé osseuse</li> <li>Risque plus élevé d’infection</li> </ul> <p>La bonne nouvelle est que bon nombre de ces effets secondaires sont réversibles et que leur gravité tend à diminuer de pair avec la dose.</p> <h2>Traitement par rituximab</h2> <p>Le <a href="/Article?contentid=233&language=French">Rituximab</a> est un agent biologique qui cible les lymphocytes B. Pour rappel, les lymphocytes B sont les cellules immunitaires responsables de la production des anticorps. Le rituximab agit par déplétion des lymphocytes B de l’organisme, inhibant ainsi la production des auto-anticorps à l’origine de l’inflammation dans le cerveau. Les anciens lymphocytes B finissent par être remplacés par une nouvelle population – saine – de lymphocytes B.</p> <p>Le rituximab est administré par voie intraveineuse, à l’hôpital, sur plusieurs heures. Cette technique est connue sous le nom de perfusion. L’administration de rituximab peut s’accompagner d’effets secondaires pendant ou juste après la ​perfusion. D’autres effets secondaires possibles chez l’enfant qui prend du rituximab sont entre autres : </p> <ul> <li>Fatigue</li> <li>Raideur musculaire</li> <li><a href="/Article?contentid=30&language=French">Fièvre</a>, frissons</li> <li>Risque plus élevé d’infection </li> </ul> <h2>Traitement par immunoglobulines intraveineuses</h2> <p>Les <a href="/Article?contentid=161&language=French">immunoglobulines intraveineuses (IgIV) </a> sont un produit sanguin administré par voie intraveineuse composé d’anticorps mélangés provenant de centaines de donneurs de sang. Les IgIV sont efficaces dans deux situations particulières :</p> <ol> <li>quand le système immunitaire attaque les protéines de l’organisme, comme dans les affections inflammatoires liées à la présence d’anticorps</li> <li>en cas de suppression ou d’inhibition du système immunitaire. Cette situation se produit chez les patients qui ont un très faible taux de globules blancs dans le sang.</li> </ol> <p>Les anticorps des donneurs agissent contre la maladie liée à la présence d’anticorps en se liant à l’auto-anticorps anormal et en stimulant son élimination. En outre, les IgIV étant composées d’anticorps provenant de centaines de donneurs, elles contribuent également à renforcer le système immunitaire en assurant la même fonction que les anticorps natifs de l’organisme.</p> <p>Les IgIV sont très bien tolérées. Des réactions à la perfusion sont possibles, mais elles peuvent être réduites ou stoppées en modifiant la vitesse de la perfusion. </p> <h2>Traitement par plasmaphérèse</h2> <p>La plasmaphérèse est une intervention réservée aux patients très malades. Il s’agit d’une technique de purification du sang qui ​s’utilise le plus souvent chez les patients atteints d’une maladie auto-immune. Elle consiste à prélever du sang à un patient par un cathéter inséré dans une veine. Le sang est filtré pour séparer la fraction liquide, le plasma, de la fraction cellulaire qui contient tous les globules rouges et blancs. Le plasma est prélevé, remplacé et retourné au patient par perfusion. Les anticorps circulent dans le plasma. La plasmaphérèse agit en éliminant du plasma tous les anticorps circulants tenus pour responsables de l’inflammation dans l’organisme.</p>

 

 

Antibody-mediated inflammatory brain disease (treatment)1174.00000000000Antibody-mediated inflammatory brain disease (treatment)Antibody-mediated inflammatory brain disease (treatment)AEnglishImmunologyChild (0-12 years);Teen (13-18 years)BrainImmune systemDrug treatmentCaregivers Adult (19+)NA2013-05-13T04:00:00Z​Susanne Benseler, MD;Manisha Sickand, MSc;Marinka Twilt, MD11.000000000000043.0000000000000789.000000000000Health (A-Z) - ProcedureHealth A-Z<p>Antibody-mediated inflammatory brain disease is treated with medications to control active inflammation and eliminate disease-causing antibodies.</p><h2>Treatment of antibody-mediated inflammatory brain disease</h2> <p>The primary treatment goals in <a href="/Article?contentid=927&language=English">antibody-mediated inflammatory brain disease</a> are to:</p> <ol> <li>Control active <a href="/Article?contentid=926&language=English">inflammation</a> </li> <li>Reduce and ultimately eliminate disease-causing antibodies</li> </ol> <p>Various treatments can be used to achieve these goals. However, the following comprise the mainstay of current treatment.</p><h2>Key points</h2> <ul> <li>Treatment goals for antibody-mediated inflammatory brain disease include controlling active inflammation and eliminating disease-causing antibodies.</li> <li>Treatment may include prednisone, rituximab, intravenous immunoglobulin and plasmapheresis.</li> <li>It is important that you ensure your child's immunizations are up-to-date because treatment can suppress the immune system. However, while on treatment, your child should not take any live vaccines.</li> </ul><h2>What about vaccines</h2> <p>Because many of the treatments for inflammatory brain disease suppress the immune system, it is very important that you ensure your child's immunizations are up-to-date. However, while on treatment, your child should not take any live vaccines. Live vaccines are immunizations that use an attenuated form of the microorganism to initiate an immune response. Examples include: </p> <ul> <li>MMR (<a href="/Article?contentid=752&language=English">measles</a>, <a href="/Article?contentid=753&language=English">mumps</a>, <a href="/Article?contentid=758&language=English">rubella</a>) </li> <li><a href="/Article?contentid=760&language=English">Chickenpox (Varicella)</a> </li> <li>Oral influenza vaccine </li> </ul> <p>Patients with antibody-mediated inflammatory disorders are on similar medications as those with other inflammatory brain diseases such as <a href="/Article?contentid=914&language=English">CNS vasculitis</a>.</p><h2>Treatment using prednisone</h2> <p><a href="/Article?contentid=221&language=English">Prednisone</a> is a steroid drug that inhibits various immune cells in the body. As a result, it plays a crucial role in preventing the inflammation associated with antibody-mediated reactions. Prednisone is usually one of the first-line medications when doctors believe the immune system is involved in your child's symptoms. Prednisone is given for a long time as this allows the immune system to reset itself and produce a new set of immune cells that do not attack your own proteins. Your physician will gradually reduce the prednisone dose, it is very important that you adhere to this regimen so that your body can properly adjust to the changes. </p> <p>Unfortunately, prednisone does have various unpleasant side effects; the main ones are listed below: </p> <ul> <li>Weight gain, especially in the cheeks and belly </li> <li>Hair growth, stretch marks, acne </li> <li>High blood pressure, high blood sugar, decreased bone health </li> <li>Higher risk of infection </li> </ul> <p>The good news is that many side effects are reversible and they tend to reduce in severity as the dose is lowered.</p> <h2>Treatment using rituximab</h2> <p><a href="/Article?contentid=233&language=English">Rituximab</a> is a biologic agent that targets your B cells. Remember, your B cells are the immune cells responsible for producing antibodies. Rituximab works by depleting your body's B cells and in doing so, also inhibits the production of auto-antibodies that are causing inflammation in the brain. The old B cells are eventually replaced by a new, healthy population of B cells. </p> <p>Rituximab is administered intravenously in the hospital over the course of several hours, also known as an infusion. Rituximab can be accompanied by some side effects during the infusion or shortly thereafter. Other side effects your child may experience while taking rituximab include: </p> <ul> <li>Tiredness </li> <li>Muscle stiffness </li> <li><a href="/Article?contentid=30&language=English">Fever</a>, chills</li> <li>Higher risk of infection </li> </ul> <h2>Treatment using intravenous immunoglobulin</h2> <p><a href="/Article?contentid=161&language=English">Intravenous immunoglobulin (IVIG)</a> is an intravenously administered blood product that consists of pooled antibodies from hundreds of blood donors. IVIG is effective in two particular situations:</p> <ol> <li>When the immune system attacks the body's own proteins, as we see in antibody-mediated inflammatory conditions.</li> <li>When the immune system is suppressed or inhibited. This occurs in patients who have very low white blood cell counts. </li> </ol> <p>The donor antibodies work to treat antibody-mediated disease by binding to the abnormal autoantibody and stimulating its removal. In addition, since IVIG is comprised of hundreds of donor antibodies, it also helps to boost the immune system by performing the same function as your body's native antibodies. </p> <p>IVIG is very well tolerated. Infusion reactions are possible, but can be reduced or stopped by altering the rate at which the infusion occurs.</p> <h2>Treatment using plasmapheresis</h2> <p>Plasmapheresis is a procedure that is reserved for patients who are very sick. Plasmapheresis is a blood purification procedure used most often in patients with autoimmune conditions. The procedure involves the removal of blood through a catheter placed in a patients' vein. The blood is filtered so that the liquid portion called plasma, is separated from the cellular portion that contains all the red and white blood cells. The plasma is removed , replaced and transfused back into the patient. Antibodies circulate in the plasma. Plasmapheresis works because it clears the plasma of all the circulating antibodies thought to be causing inflammation in the body. </p><h2>Other treatment options</h2> <p>It is important to note that not all patients will respond the exact same way to these treatments. Various factors impact the disease process as well as the response to treatment. For this reason, an absolute treatment protocol does not exist, research is ongoing and we learn more and more about these rare conditions every day. Other drugs that have been studied and have proven successful in selective groups of patients include: </p> <ul> <li><a href="/Article?contentid=80&language=English">Azathioprine</a> AKA Imuran (Costanzi et al., 2011) </li> <li>Tocilizimab, another biologic agent that targets a cytokine receptor (Araki et al., 2012) </li> <li>Cyclophospamide (Dalmau et al., 2008; Hughes et al., 2010) </li> </ul> <p>Various treatments may also be added for control of symptoms and side effects such as anti-seizure medications, antibiotics and anti-psychotics. </p>Antibody-mediated inflammatory brain disease (treatment)

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