Pharmacotherapy of Rasmussen’s Encephalitis: A Comparison of Epilepsia Partialis Continua with Rituximab and Azathioprine

Rasmussen’s Encephalitis is a rare neurological condition causing inflammation of the brain, which thereafter can result in seizures, neuronal death, and significant neurological deficits. Its exact cause is unknown and it typically presents in children. The best known treatment is a surgical hemispherectomy to prevent the spread of inflammation, however this is invasive and not without risk. The best therapeutic approach has been with immunomodulation using the antimetabolite agent, azathioprine. Monoclonal antibodies such as rituximab have shown promise in early clinical trials for the treatment of Rasmussen’s Encephalitis, but little has been done to compare the efficacy of rituximab versus azathioprine.
A systematic review was then conducted with a study in which patients were treated with rituximab for Rasmussen’s Encephalitis (RE) compared to a study in which patients were treated with azathioprine. The presence of focal encephalitis characterized by epilepsia partialis continua (EPC) was measured in both studies following the treatments.
Azathioprine and Rituximab both had statistically significant effects on decreasing the incidence of epilepsia partialis continua when compared to their respective controls. However, rituximab seemed to have a greater effect on reducing the incidence of EPC than azathioprine.
Rituximab seems to have an immense potential in reducing EPC in patients with RE. For this review, Rituximab seemed to have a greater reduction in EPC than azathioprine. Further studies with greater sample sizes assessing reductions in the several other complications of RE must be conducted in order to confirm whether or not Rituximab is truly a better choice than Azathioprine.