Association between autoimmune encephalitis and epilepsy: Systematic review and meta-analysis

Lu, Ciyong; Zhu, Lin; Lü, Di; Dai, Shujuan; Han, Yanbing; Wu, Zhe; Xu, Puying; Chang, Lvhua; Qian, Wei

doi:10.1016/j.seizure.2021.07.005

Cited by 20 publications

(7 citation statements)

References 64 publications

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“…As reported, seizures were thought to be the predominant manifestation in AE [ 26 ]. In a very recent meta-analysis, the overall incidence of AE patients with seizures was 42%, and in the anti-NMDAR encephalitis patients, the rate increased to 73% [ 37 ]. Anti-NMDAR encephalitis is the most common type of AE in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of brain FDG PET/CT imaging in pediatric patients with suspected autoimmune encephalitis from a prospective study

Yin

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose Early diagnosis and treatment are of paramount importance for pediatric patients with autoimmune encephalitis (AE). The aim is to evaluate the usefulness of FDG PET/CT in pediatric patients with suspected AE from a prospective study. Methods The prospective study was conducted over a period of 23.5 months from May 14, 2019, to April 30, 2021. All patients (< 18-year-old) were hospitalized at the department of pediatric neurology and met the criteria of clinical suspected AE. The children underwent the tests of blood samplings, CSF, EEG, MRI, and 18F-FDG PET/CT. The criteria for FDG PET/CT diagnosis of AE were large lobar hypometabolism with or without focal hypermetabolism found on PET/CT. The clinical final diagnosis of AE includes seropositive and seronegative AE based on the diagnostic criteria. Results One hundred four pediatric inpatients (57 boys, 47 girls) were included, of which 58 children were diagnosed with AE (seropositive, 16; seronegative, 42), 45 children were diagnosed with non-AE, and one boy remained indeterminate diagnosis. Large lobar hypometabolism was found in 61 children, of which 54 (88.5%) children were finally diagnosed with AE. The sensitivity, specificity, and accuracy of FDG PET/CT for diagnosis of AE were 93.1%, 84.4%, and 89.3%, respectively, with a positive predictive value of 88.5% and a negative predictive value of 90.5%. The most common involved with hypometabolism was the parietal lobe, followed by occipital and frontal lobes, finally the temporal lobe on PET/CT in children with AE. Conclusion Brain FDG PET/CT imaging has high specificity, sensitivity, and accuracy for diagnosis of AE in clinical suspected AE children. Trial registration. Clinical Trials.gov. NCT02969213. Registered 17 October 2016.

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Section: Discussionmentioning

confidence: 99%

Usefulness of brain FDG PET/CT imaging in pediatric patients with suspected autoimmune encephalitis from a prospective study

Yin

et al. 2021

Eur J Nucl Med Mol Imaging

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“…Among epileptic disorders related to autoimmunity, it is important to distinguish between immune-mediated encephalitis (especially autoimmune limbic encephalitis (ALE)) and autoimmune-associated epilepsy (AAE), a chronic epileptic syndrome with the capacity for spontaneous recurrence of seizures in the long term [39]. The relationship between ALE and the risk of subsequently developing chronic epilepsy remains unclear and is considered to be mainly related to the nature of the associated neuronal antibody [40]:…”

Section: Epileptogenesis Mediated By Peripheral Immunitymentioning

confidence: 99%

Immune Mechanism of Epileptogenesis and Related Therapeutic Strategies

et al. 2022

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Immunologic and neuroinflammatory pathways have been found to play a major role in the pathogenesis of many neurological disorders such as epilepsy, proposing the use of novel therapeutic strategies. In the era of personalized medicine and in the face of the exhaustion of anti-seizure therapeutic resources, it is worth looking at the current or future possibilities that neuroimmunomodulator or anti-inflammatory therapy can offer us in the management of patients with epilepsy. For this reason, we performed a narrative review on the recent advances on the basic epileptogenic mechanisms related to the activation of immunity or neuroinflammation with special attention to current and future opportunities for novel treatments in epilepsy. Neuroinflammation can be considered a universal phenomenon and occurs in structural, infectious, post-traumatic, autoimmune, or even genetically based epilepsies. The emerging research developed in recent years has allowed us to identify the main molecular pathways involved in these processes. These molecular pathways could constitute future therapeutic targets for epilepsy. Different drugs current or in development have demonstrated their capacity to inhibit or modulate molecular pathways involved in the immunologic or neuroinflammatory mechanisms described in epilepsy. Some of them should be tested in the future as possible antiepileptic drugs.

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“…In general, NMDAR encephalitis is diagnosed by the presence of well-established pathogenic anti-NMDAR autoantibodies in CSF together with the compatible clinical picture. Seizures occur in 75% of cases and can be the predominant symptom ( 9 , 15 , 16 ). Also, anti-NMDAR autoantibodies were frequent (4.8%) in some cohorts of epilepsy patients ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

High frequency of cerebrospinal fluid autoantibodies in patients with seizures or epilepsies of unknown etiology

et al. 2023

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IntroductionThe increasing identification of specific autoantibodies against brain structures allows further refinement of the group of autoimmune-associated epilepsies and affects diagnostic and therapeutic algorithms. The early etiological allocation of a first seizure is particularly challenging, and the contribution of cerebrospinal fluid (CSF) analysis is not fully understood.MethodsIn this retrospective study with a mean of 7.8 years follow-up involving 39 well-characterized patients with the initial diagnosis of new-onset seizure or epilepsy of unknown etiology and 24 controls, we determined the frequency of autoantibodies to brain proteins in CSF/serum pairs using cell-based assays and unbiased immunofluorescence staining of unfixed murine brain sections.ResultsAutoantibodies were detected in the CSF of 30.8% of patients. Underlying antigens involved glial fibrillary acidic protein (GFAP) and N-methyl-D-aspartate (NMDA) receptors, but also a range of yet undetermined epitopes on neurons, glial and vascular cells. While antibody-positive patients had higher frequencies of cancer, they did not differ from antibody-negative patients with respect to seizure type, electroencephalography (EEG) and cranial magnetic resonance imaging (cMRI) findings, neuropsychiatric comorbidities or pre-existing autoimmune diseases. In 5.1% of patients with seizures or epilepsy of initially presumed unknown etiology, mostly CSF findings resulted in etiological reallocation as autoimmune-associated epilepy.DiscussionThese findings strengthen the potential role for routine CSF analysis. Further studies are needed to understand the autoantibody contribution to etiologically unclear epilepsies, including determining the antigenic targets of underlying autoantibodies.

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Association between autoimmune encephalitis and epilepsy: Systematic review and meta-analysis

Cited by 20 publications

References 64 publications

Usefulness of brain FDG PET/CT imaging in pediatric patients with suspected autoimmune encephalitis from a prospective study

Usefulness of brain FDG PET/CT imaging in pediatric patients with suspected autoimmune encephalitis from a prospective study

Immune Mechanism of Epileptogenesis and Related Therapeutic Strategies

High frequency of cerebrospinal fluid autoantibodies in patients with seizures or epilepsies of unknown etiology

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