Autoimmune Encephalitis–Related Seizures and Epilepsy: Diagnostic and Therapeutic Approaches

Chen, Baibing; Chiriboga, A. Sebastian López; Sirven, Joseph I; Feyissa, Anteneh M.

doi:10.1016/j.mayocp.2021.02.019

Cited by 17 publications

(17 citation statements)

References 48 publications

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“…A previous study also found that anti-NMDR encephalitis was the most common AE antibody ( 26 ). It is worth noting that anti-IGI1 was detected in both CSF and serum, and anti-Hu IgG was detected in only serum in this study, which is different from previous studies ( 17 , 26 , 27 ). Whether these antibodies with a very low positive rate are detected in CSF or serum, more research is needed to draw corresponding conclusions.…”

Section: Discussioncontrasting

confidence: 99%

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The Antibody Assay in Suspected Autoimmune Encephalitis From Positive Rate to Test Strategies

et al. 2022

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ObjectiveThe aim of this study was to analyze the positive rate and test strategies of suspected autoimmune encephalitis (SAE) based on an antibody assay.MethodsPatients who were diagnosed with suspected autoimmune encephalitis in Guizhou Province between June 1, 2020, and June 30, 2021 and who had anti-neuronal autoantibodies detected by Guizhou KingMed Diagnostics Group Co., Ltd. were included in this study. The positive rate and the test strategies were analyzed based on the results of the anti-neuronal antibody assay.ResultsA total of 263 patients with SAE were included, 58.2% (153/263) of whom were males, with a median age of 33 years (1-84 years). 84% (221/263) of all patients completed both serum and CSF tests. A total of 46.0% (121/263) of SAE patients received the AE-6 examination package. The antibody-positive rate was 9.9% (26/263) in the current cohort, with an observed incidence of antibody positive of 0.2 in 100,000 (26/11,570,000, 95% CI: 0.15-0.30), and the estimated incidence was 0.9 in 100,000 (95% CI: 0.84-0.95) of the total population. A total of 9 different anti-neuronal antibodies were detected. Anti-NMDAR antibody was the most common antibody in 46.2% (12/26) of subjects, 70.0% (7/10) of whom were children, followed by anti-Caspr2 antibody in 30.8% (8/26); the remaining 7 antibodies were detected in 23.1% (6/26) of the population. There were no obvious differences among age, sex or season in the positive rate of anti-neuronal antibodies. The cost of antibody testing per capita was $439.30 (SD±$195.10). The total cost of AE-14 was the highest at $48.016.81 (41.56%) among all examination packages.ConclusionsThis study described the positive rate associated with AE-related anti-neuronal antibodies and test strategies in the current cohort, which provides a basis for clinicians in clinical practice.

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Section: Discussioncontrasting

confidence: 99%

“…The cost of antibody testing per capita was $439.30. The detection of antibodies is extremely important for the diagnosis and treatment of AE (16)(17)(18). Early diagnosis, early intervention and early treatment of AE can significantly improve the survival rate and prognosis (5,18).…”

Section: Discussionmentioning

confidence: 99%

The Antibody Assay in Suspected Autoimmune Encephalitis From Positive Rate to Test Strategies

et al. 2022

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“…As adapted from the conceptual definition of acute symptomatic seizures secondary to autoimmune encephalitis (AE) by the International League Against Epilepsy (ILAE), 16 we propose the terminology as “acute symptomatic seizures secondary to MS/AQP4‐NMOSD/MOGAD.” This term refers to seizures that occur as a symptom of acute attacks of MS/AQP4‐NMOSD/MOGAD and are also commonly accompanied by other symptoms of demyelinating diseases 7,10,17,18 . Similar to acute symptomatic seizures secondary to AE, acute symptomatic seizures secondary to MS/AQP4‐NMOSD/MOGAD are refractory to ASMs but show excellent response to immuotherapy 16,19 . However, in contrast to AE, seizures have a lesser prevalence in MS/AQP4‐NMOSD/MOGAD 5,15,19,20 .…”

Section: Definitionmentioning

confidence: 99%

“…Therefore, adapted from term “autoimmune‐associated epilepsy in AE,” 16 we propose the terminology “autoimmune‐associated epilepsy in MS/AQP4‐NMOSD/MOGAD,” to emphasize that immune dysregulations and/or postdemyelination structural damage are responsible for the seizure‐prone states in these patients 16 . Also, similar to that in AE, autoimmune‐associated epilepsy in MS/AQP4‐NMOSD/MOGAD has a poor response to immunotherapy and requires long‐term ASM therapy 16,19 . The difference between autoimmune‐associated epilepsy in MS/AQP4‐NMOSD/MOGAD and that in AE also lies in prevalence and the underlying pathogenesis 21,22,28 …”

Section: Definitionmentioning

confidence: 99%

“…7,10,17,18 Similar to acute symptomatic seizures secondary to AE, acute symptomatic seizures secondary to MS/AQP4-NMOSD/MOGAD are refractory to ASMs but show excellent response to immuotherapy. 16,19 However, in contrast to AE, seizures have a lesser prevalence in MS/AQP4-NMOSD/MOGAD. 5,15,19,20 This can be attributed to a direct blow to neurons by antibodies in AE, versus glia-mediated damage in inflammatory demyelinating disorders.…”

Section: Acute Symptomatic Seizures Secondary To Ms/aqp4-nmosd/mogadmentioning

confidence: 99%

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Seizures and epilepsy in multiple sclerosis, aquaporin 4 antibody‐positive neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody‐associated disease

Zheng

Cai

et al. 2022

Epilepsia

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Seizure is one of the manifestations of central nervous system inflammatory demyelinating diseases, which mainly include multiple sclerosis (MS), aquaporin 4 antibody‐positive neuromyelitis optica spectrum disorder (AQP4‐NMOSD), and myelin oligodendrocyte glycoprotein antibody‐associated disease (MOGAD). Acute symptomatic seizures secondary to MS/AQP4‐NMOSD/MOGAD occur in the acute phase of the diseases, and are more frequent in MOGAD. In contrast, recurrent nonprovoked seizures, mainly attributed to autoimmune‐associated epilepsy, occur in the nonacute phase of the diseases. Seizures in MS/AQP4‐NMOSD/MOGAD mostly have a focal onset. MS patients with concomitant systemic infections, earlier onset, and greater disease activity are more likely to have seizures, whereas factors such as greater MS severity, the presence of status epilepticus, and cortical damage indicate a greater risk of developing epilepsy. In MOGAD, cerebral cortical encephalitis and acute disseminated encephalomyelitis (ADEM)‐like phenotypes (predominately ADEM and multiphasic disseminated encephalomyelitis) indicate a greater seizure risk. Multiple relapses with ADEM‐like phenotypes predict epilepsy in pediatrics with MOGAD. Pathophysiologically, acute symptomatic seizures in MS are associated with neuronal hyperexcitability secondary to inflammation and demyelination. Chronic epilepsy in MS is largely due to gliosis, neuronal dysfunction, and synaptic abnormalities. The mainstay of treatment for seizures secondary to MS/AQP4‐NMOSD/MOGAD consists of immunotherapy along with antiseizure medications. This critical review discusses the most‐updated evidence on epidemiology, clinical correlates, and inflammatory mechanisms underlying seizures and epilepsy in MS/AQP4‐NMOSD/MOGAD. Treatment cautions including drug‐drug interactions and the impact of treatments on the diseases are outlined. We also highlight pitfalls and challenges in managing such patients and future research perspectives to address unsolved questions.

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Association of New-Onset Seizures With SARS-CoV-2 Vaccines

Rafati,

Jameie,

Amanollahi

et al. 2024

JAMA Neurol

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ImportanceSeizures have been reported as an adverse effect of the SARS-CoV-2 vaccine. However, no study has answered the question of whether there is any association between seizures in the general population and COVID-19 vaccination.ObjectiveTo evaluate the seizure incidence among SARS-CoV-2 vaccine recipients compared with those who received a placebo.Data SourcesA systematic search of MEDLINE (via PubMed), Web of Science, Scopus, Cochrane Library, Google Scholar, review publications, editorials, letters to editors, and conference papers, along with the references of the included studies from December 2019 to July 7, 2023.Study SelectionRandomized clinical trials (RCTs) reporting seizure incidence with SARS-CoV-2 vaccination were included.Data Extraction and SynthesisThis study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework and used the Mantel-Haenszel method with random- and common-effect models. The risk of bias of the studies was assessed using the Cochrane assessment tool for RCTs.Main Outcomes and MeasuresThe outcome of interest was new-onset seizure incidence proportion compared among (1) SARS-CoV-2 vaccine recipients and (2) placebo recipients.ResultsSix RCTs were included in the study. Results of the pooled analysis comparing the incidence of new-onset seizure between the 63 521 vaccine and 54 919 placebo recipients in the 28-day follow-up after vaccine/placebo injection showed no statistically significant difference between the 2 groups (9 events [0.014%] in vaccine and 1 event [0.002%] in placebo recipients; odds ratio [OR], 2.70; 95% CI, 0.76-9.57; P = .12; I2 = 0%, τ2 = 0, Cochran Q P = .74). Likewise, in the entire blinded-phase period after injection, with a median of more than 43 days, no significant difference was identified between the vaccine and placebo groups regarding incident new-onset seizure (13/43 724 events [0.03%] in vaccine and 5/40 612 [0.012%] in placebo recipients; OR, 2.31; 95% CI, 0.86-3.23, P &gt; .99, I2 = 0%, τ2 = 0, Cochran Q P = .95).Conclusions and RelevanceAccording to this systematic review and meta-analysis, there was no statistically significant difference in the risk of new-onset seizure incidence between vaccinated individuals and placebo recipients.

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Autoimmune Encephalitis–Related Seizures and Epilepsy: Diagnostic and Therapeutic Approaches

Cited by 17 publications

References 48 publications

The Antibody Assay in Suspected Autoimmune Encephalitis From Positive Rate to Test Strategies

The Antibody Assay in Suspected Autoimmune Encephalitis From Positive Rate to Test Strategies

Seizures and epilepsy in multiple sclerosis, aquaporin 4 antibody‐positive neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody‐associated disease

Association of New-Onset Seizures With SARS-CoV-2 Vaccines

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