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Treatments

 

At this time there is no recommended therapies for the treatment of ANE in the acute stage. Intensive care, symptomatic treatment and empirical treatments such as the use of anti virals and immunomodulatory agents are tested in the majority of cases. The following are therapies that may be used for ANE patients as decided by their treating physicians. Since no ANE patient is identical to another, hence no two patient treatments will be identical. The majority of patients will be placed in a drug induced coma. Attending Doctors and Neurologists will assess the situation carefully and treat the patient according to their needs. Please note the information in this website is intended as a general information/ discussion guideline only. It should never be construed as medical advice.

corticosteroids

Corticosteroids are synthetic drugs that are used to treat a wide variety of disorders, including asthma, arthritis, skin conditions and autoimmune diseases. Corticosteroids work by decreasing inflammation and suppressing the immune system. The drug mimics cortisol, a hormone that’s naturally produced by the adrenal glands in healthy people.

Plasmapheresis

Plasmapheresis is a process in which the liquid part of the blood, or plasma, is separated from the blood cells. … If you’re sick, your plasma can contain antibodies that attack the immune system. A machine can be used to remove the affected plasma and replace it with good plasma or a plasma substitute.

IVIG

Intravenous immunoglobulin (IVIg) is a solution of human plasma proteins and in particular IgG antibodies with a broad spectrum of antibody activity. IVIg is prepared from large pools of human plasma collected from several thousand blood donors and contains the typical IgG antibodies found in the normal population. IVIg is used for patients who need replacement of antibodies and also for autoimmune disorders.

Therapeutic hypothermia

Therapeutic hypothermia is the intentional reduction of core body temperature to 32°C – 35°C, and is increasingly applied by intensivists for a variety of acute neurological injuries to achieve neuroprotection and the reduction of increased intracranial pressure.

TNF Inhibitors and IL6 Blockers

Tumour necrosis factor-α (TNF-α) is a pro-inflammatory cytokine known to have a critical role in the pathogenesis of various inflammatory or immune mediated diseases. TNF-α inhibitors are biological agents that specifically target these inflammatory mediators.

Tocilizumab is a monoclonal antibody against the interleukin-6 receptor (IL-6R). Interleukin 6 (IL-6) is a cytokine that plays an important role in immune response and is implicated in the pathogenesis of many diseases, such as autoimmune diseases.

Favorable Outcomes With Early Interleukin 6 Receptor Blockade in Severe Acute Necrotizing Encephalopathy of childhood.  https://www.pedneur.com/article/S0887-8994(19)30144-4/fulltext

 

coma inducing drugs

A medically induced coma is when a patient receives a controlled dose of an anesthetic, typically propofol, pentobarbital or thiopental, to cause a temporary coma or a deep state of unconsciousness. This type of coma is used to protect the brain from swelling by reducing the metabolic rate of brain tissue, as well as the cerebral blood flow. Throughout a medically induced coma, a patient’s critical life functions are constantly monitored by an anesthesiologist or other physician in a critical care setting only.

Procedural & Diagnostic Tools

 MRI and CT Scan – These 2 medical tests are used to examine the structure of the brain and scan in cross sections. The MRI uses magnetic fields and the CT uses x-rays. The MRI may see an injury to the brain that can go undetected in a CT scan as it has a higher resolution.

EEG – Using electrodes placed on the skull, an EEG records electrical signals coming from the brain. A slowing of these signals may indicate a lesion whilst widespread slowing may indicate a wider disturbance of the brain function. An EEG may be used to confirm diagnosis from other tests.

Intracranial Pressure Monitor – Doctors may insert one of these monitors into the skull if they are concerned about pressure from inflammation in the acute stage of injury.

Lumbar Puncture – This is a diagnostic test where fluid is extracted from the spinal column. Pressure on the spinal column is measured and the cerebro-spinal (CSF) fluid is then examined for viral cultures, elevated white cell counts and blood. In the majority of cases, ANE patient’s CSF will show elevated protein and no viral pathogen.

Breathing Assistance – A Tracheal Intubation or Tracheotomy is sometimes performed, as well as careful montoring of breathing and heart function.

Genetic Testing – It is becoming more common to have ANE patients tested for the genetic mutations. It is a simple blood test. Some hospitals will do the testing as a matter of course. Testing may be done “in house” at the hospital, if they they have the facilities to do so. However, some hospitals may send the samples overseas to an appropriate testing facility.

 

Medical Assistance & Other Medications

Anticonvulsant Medications

These drugs can help stop or prevent seizures. Most ANE patients will have seizures at the onset of ANE. These seizures can be quite dramatic (tonic/clonic) or almost unnoticable (focal or generalized). Anti convulsant medication may have a sedative effect. The most common drug used is Keppra. For a list of other types of anti convulsant medication see –

https://en.wikipedia.org/wiki/Anticonvulsant#Benzodiazepines.

Antipsychotic Drugs
These drugs may sometimes be used in post-traumatic brain injury to treat agitation, disruptive behaviour and/or agressive behaviour as the brain heals.

Tamiflu (Oseltamivir)
This is an anti viral drug used for the treatment of influenza. It works by slowing down the rate at which viruses infect cells. It does not eliminate the flu virus, rather it slows its progress. It needs to be taken early in the infection cycle and hence some ANE patient’s treating physicians may recommend it be taken at the first sign of influenza or viral illness to guard against recurrence of ANE.

Melatonin
Sometimes, Melatonin is prescribed to helps control the sleep and wake cycles in ANE patients and other ABI patients.

Antibiotics
Until a bacterial infection is ruled out, antibiotics can sometimes be used for prophylactic measures. These will be used if ANE is caused by a bacteria.

Nutritional Assistance
Nasogastric Intubation (NgTube via the nasal passage) or Gastric Intubation (GTube via abdomen walls) is a common procedure that provides access to the stomach for feeding.

 

Intravenous Fluids (IV’s)

Intravenous therapy is the infusion of liquid substances directly into a vein. ANE patients may have the following fluids administered through an IV line. Rehydration fluids after becoming dehydrated, antibiotics , steroids and pain management medications.