CPI Combination Therapy for Autoimmune Encephalitis

Inclusion criteria:

1. 14-65 years old;

2. met all the three following diagnostic criteria of AE: (i) subacute onset (rapidprogress of less than 3 months) of working memory deficits, altered mental status,or psychiatric symptoms; (ii) at least one of the followings: new focal CNSfindings, seizures not explained by a previously known disease, cerebrospinal fluid (CSF) pleocytosis (white blood cell count 5 cells/mm3), magnetic resonance imaging (MRI) features suggestive of encephalitis, and (iii) reasonable exclusion ofalternative causes;

3. the presence of antibody against neuronal surface antigen in serum or CSF indicatinga positive diagnosis of AE using a cell-based assay;

4. critically ill with a modified Rankin scale (mRS) score of 4 to 5;

5. within 3 months of onset;

6. no immunotherapy previously.

Exclusion criteria:

1. relative contraindications of TPE treatment: serious underlying diseases such assevere active hemorrhage, disseminated intravascular coagulation, severe hypotensionor shock, unstable cardiac failure, cerebral herniation, severe infection or otherendangered conditions;

2. allergic to immunoglobulin;

3. contraindications of glucocorticoid therapy: glucocorticoid allergy, active gastricor duodenal ulcer, severe osteoporosis, diabetes, hypertension after recentgastrointestinal anastomosis, and serious infection that cannot be controlled byantibiotics;

4. serious underlying diseases, such as cardiac dysfunction, arrhythmia, andcoagulation disorders;

5. premorbid mRS ≥ 3.