title: A case of Rasmussen encephalitis treated with rituximab.
abstract: BACKGROUND
  A 20-year-old woman was referred to our intensive care unit with a high frequency (every 1-2 min) of focal motor seizures. She had been diagnosed as having biopsy-proven Rasmussen encephalitis (RE) of the right hemisphere 7 years previously, since when she had been treated with numerous antiepileptic drugs, as well as with continuous immunotherapies, such as tacrolimus, corticosteroids, mycophenolate mofetil, intravenous immunoglobulin and immunoadsorption. Although hemispherectomy had been avoided due to slow progression of RE, she had not been seizure-free for more than 7 weeks since diagnosis.
  
  
  METHODS
  EEG and MRI.
  
  
  METHODS
  Focal motor status epilepticus associated with right hemispheric RE, causing continuous epileptic activity and unilateral atrophy with edema in the right hemisphere.
  
  
  RESULTS
  Immunoadsorption was used initially to treat the seizures. Once they had ceased, we used 375 mg/m2 intravenous rituximab--a monoclonal anti-CD20 antibody--once-weekly for 4 weeks to stabilize the condition, leading to complete depletion of CD19+ B cells. Rituximab infusions were used again when concentrations of CD19+ B cells rose and focal seizures re-emerged. The patient remained on antiepileptic therapy (levetiracetam, oxcarbazepine, zonisamide and phenobarbital) throughout treatment.
authors: Department of Neurology, Christianalbrechts-University, Kiel, Germany. b.thilo@neurologie.uni-kiel.de
authors: Barbara
authors: B
authors: Thilo
authors: Robert
authors: R
authors: Stingele
authors: Karina
authors: K
authors: Knudsen
authors: Rainer
authors: R
authors: Boor
authors: Christian G
authors: CG
authors: Bien
authors: Günther
authors: G
authors: Deuschl
authors: Nicolas
authors: N
authors: Lang
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19 / Q000276:immunology / Q000378:metabolism; D018951:Antigens, CD20 / Q000627:therapeutic use; D016175:B-Lymphocyte Subsets / Q000187:drug effects / Q000276:immunology / Q000378:metabolism; D004660:Encephalitis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D000069283:Rituximab; D013226:Status Epilepticus / Q000150:complications* / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19; D018951:Antigens, CD20; D007155:Immunologic Factors; D000069283:Rituximab