Table 3 Case 1-3: Immunological and radiological findings, presence of Red Flags, and changes 24 months after Rituximab treatment.
Case 1 | Case 2 | Case 3 | |
|---|---|---|---|
FINDINGS | Elevated CSF-lgG, Unmatched OCBs; CaM II kinase activity (150%); EEG: Not done; MRI: Normal; 18FDG-PET: Low uptake in anterior cingulum, right cerebellar hemisphere and medial of the posterior horn | Positive DRD1-Ab and beta-Tub Ab, EEG Normal, MRI: Normal. 18FDG-PET: Not done | Unmatched OCBs, CaM II kinase activity (150%), EEG Normal. MRI with Hyperintense punctiform subcortical white substance changes, 18FDG-PET: Normal |
RED FLAGS AUTOIMMUNE OCD | 4 definite | 6 definite + 1 suspected | 3 definite + 4 suspected |
RITUXIMAB TREATMENT | Six rounds a 1 g every 6 months, starting in late 20 s | Five rounds a 1 g every 6 months, starting in early adulthood | Five rounds a 1 g every 6 months, starting in mid-30s |
Change 24 months after rituximab initiation | |||
AFFECTIVE SYMPTOMS | Improved for 2 years then relapse (after 2.5 years) | Improved | Improved |
SLEEP | Normalized (from 12 h/d to 7,5 h/d) | Normalized without sleep medication (from 12 h/d to 8-9 h/d) | Improved without sleep medication, improved energy |
MOTOR SYMPTOMS | - | Improved | - |
ABILITY TO WORK/ SCHOOL | Increased from 0% to 100% | Improved | Increased from O to 50% |
ADL FUNCTIONS | Improved. Completed full time studies and an apprenticeship | Improved. Is more independent in cooking and cleaning. Started part-time distance studies | Improved. Started new part-time work |
COGNITION | Reports improved executive function, ability to shift focus, increased initiative and interest. Reports no longer “getting stuck”. Observably less rumination. | Reports improved executive function, ability to shift focus and read advanced text. Observably less perseveration and verbigeration and improved formal communication. | Reports improved executive function, ability to shift focus and remission of subjective aphasia. Observably improved ability to organise thoughts and formal communication. During 3 years, no periods of elevated mood were observed and good adherence to treatment. |
MEDICATION | Risperidone discontinued; Sertraline was reduced from 200 to 50 mg | Discontinued all psychiatric medications (SSRI, anxiolytics, CS) | No medication |
