IMMUNOTHERAPY IN AUTOIMMUNE ENCEPHALITIS: TREATMENT STRATEGIES AND RELAPSE PREVENTION, A LITERATURE REVIEW

Abstract

Autoimmune Encephalitis (AE) has emerged as a prevalent etiology of encephalitis in the non-infectious context, demanding a swift and precise diagnostic approach due to its autoantibody-mediated pathophysiology and the potentially reversible nature of the neurological lesions. The recognition of AE, particularly the seropositive forms associated with antibodies against neuronal surface antigens, necessitates the immediate institution of immunosuppressive therapy to mitigate synaptic and neuronal damage. The present study constitutes a scoping systematic literature review published between 2020 and 2025, with the primary objective of systematizing and critically analyzing the most recent evidence guiding therapeutic intervention protocols for AE. Specifically, the focus lies on the comparative efficacy of first-line immunotherapy (such as corticosteroids, intravenous immunoglobulin, or plasma exchange), the escalation strategies for acute treatment failure, and, crucially, the role of maintenance therapy in preventing disease recurrence. Current evidence suggests that early administration of treatment, guided by time-sensitive clinical and radiological criteria, is a determining prognostic factor for functional recovery. Furthermore, the individualization of long-term prophylaxis, in which Rituximab (RTX)—an anti-CD20 agent that depletes B lymphocytes—has proven particularly effective, is considered essential.