From the International Consensus Recommendations for the Treatment of Pediatric NMDAR Antibody Encephalitis, Table 3:

3.3.1. Assessment of improvement following immunotherapy (i.e., failure to improve) is contingent on optimization of treatments for sleep, agitation, mood/behavior, dyskinesia, and seizures.

What is the meaning of this? Can I substitute "degree of improvement" instead of "assessment of improvement" here, meaning "the more you optimize the treatments of these things (sleep, agitation, etc.), the higher is the degree of improvement?

I'm not a native speaker of English, and such constructions leave me baffled sometimes.

1 Answer 1


I don't think it's especially clear what they meant by this item in the consensus statement because the document does not include much in the way of motivation or discussion of this statement, but I believe the meaning you suggest is wrong.

I think the clearest interpretation is that they are saying that "success" depends on how you define "success", and they are proposing that you should only consider efficacy of immunotherapy ("assessment of improvement following immunotherapy") when properly managing these symptoms with other drugs if needed ("contingent on optimization of treatments..."). An example might be that it's not reasonable to define "success" based only on control of seizures while ignoring sleep and mood, and also that it's not fair to consider immunotherapy as having "failed" if you didn't bother to also use other medications to treat symptoms.

The rest of section 3.3 involves other drugs given to control particular symptoms:

Use of antipsychotics and management of psychiatric symptoms should be undertaken in collaboration with a child psychiatrist

In descending order of recommendation, the following agents can be useful in the symptomatic management of agitation

In descending order of recommendation, the following agents can be useful in the symptomatic management of dyskinesia and stereotypy

Therefore, presumably by "optimizing treatments" they mean use of these other agents along with immunotherapy in treating anti-NMDAR encephalitis.

  • 2
    I think the committee is really trying to encourage these other agents: "The Panel acknowledged that although immunotherapy is the therapeutic priority to treat the underlying disease, symptomatic management (such as antiseizure medications) is equally important"
    – Ian Campbell
    Aug 15, 2022 at 20:36

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