LAUSR

To the Editor: Currently, there is no standardized treatment protocol for the pediatric anti-N-methyl-Daspartate receptor (NMDAR). There are two surveys by Kahn et al and Bartolini et al that aimed at determining the treatment strategies that are used for pediatric NMDAR encephalitis in other parts of the world rather than China. Bartolini et al performed a worldwide survey involving 399 participants: 61 adult neurologists, 86 pediatric neurologists, and52pediatric rheumatologists.Their survey investigated the differences in anti-NMDAR encephalitis treatment strategies, according tomedical specialty, years in practice, and geographical location. The survey of Kahn et al involved 151 pediatric neurologists and focused on identifying the indications for the initiation of immunotherapy, type of the used immunotherapy, length of the first-line immunotherapy, time for the initiation of the second-line immunotherapy, and the preferable options for the secondline immunotherapy. Additionally, they investigated the indications and time for adding a disease-modifying therapy, and how long should patients continue with the immunotherapy once returned to their neurologic baseline. Both surveys did not sufficiently focus on identifying the utility of the modified Rankin Scale (mRS), dosages and duration of the treatments (including the duration of oral prednisone), the utility of Cluster of Differentiation 19 positive (CD19) B cells in adjusting the dosages of rituximab, the necessity of long-term immunosuppressive treatment (for relapse prevention), and the indications for stopping the immunotherapy.