Retrospective case series of the clinical features, management and outcomes of patients with autoimmune epilepsy

Dubey, Divyanshu; Samudra, Niyatee; Gupta, Puneet; Agostini, Mark; Ding, Kan; Ness, Paul C. Van; Vernino, Steven; Hays, Ryan

doi:10.1016/j.seizure.2015.04.007

Cited by 49 publications

(49 citation statements)

References 18 publications

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“…There are still issues with a lack of standardisation, and variation can exist between clinicians (Tufenkjian and Luders, 2012). It is not uncommon that research in autoimmune epilepsy has led to reports of EEG abnormalities in the temporal region, and our study has been no different (Dubey et al, 2015;Malter et al, 2016;von Rhein et al, 2017). However, identifying the specific features highlighted above allows more accurate epilepsy classification, and this differentiation in patients with chronic autoimmune epilepsy will allow early intervention and the avoidance of potentially unnecessary invasive investigations or even surgery.…”

Section: Clinical Features Of An Immune-mediated Epilepsy Phenotypementioning

confidence: 73%

Refractory chronic epilepsy associated with neuronal auto‐antibodies: could perisylvian semiology be a clue?

Gillinder

Tjoa

Mantzioris

et al. 2017

Epileptic Disorders

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Aims. We report a case series of 10 patients with chronic medically refractory antibody‐positive autoimmune epilepsy and assess their common clinical features. Immune‐mediated seizures are most commonly reported in the context of encephalitis or encephalopathy, with few reports focusing on lone, chronic epilepsy in the outpatient setting. Our aim was to define the potential diagnostic clues that might be present in these cases, leading to consideration of an autoimmune cause of the epilepsy. Methods. We performed a retrospective review of all patients presenting to the outpatient department of our unit who underwent autoimmune screening. All patients with chronic epilepsy and a positive result for an antibody known to be associated with epilepsy were included. Results. Sixty‐three patients underwent testing. Thirteen returned a positive result, however, only 10 of these were patients which chronic epilepsy who did not present with an acute illness. Common features in these cases included: perisylvian semiology, EEG abnormalities in the mid temporal region, normal or non‐specific MRI findings, depression, and head injury. Conclusion. In cases of medically refractory, lesion‐negative epilepsy, with predominantly perisylvian semiology, clinicians should have a high level of suspicion for the diagnosis of autoimmune aetiologies and a low threshold to perform autoantibody screening. This is especially true if there are atypical electrographic findings, a previous history of head injury, or co‐morbid depression.

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Section: Clinical Features Of An Immune-mediated Epilepsy Phenotypementioning

confidence: 73%

Refractory chronic epilepsy associated with neuronal auto‐antibodies: could perisylvian semiology be a clue?

Gillinder

Tjoa

Mantzioris

et al. 2017

Epileptic Disorders

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“…The RITE score included variables from the APE score and two additional items. These were factors previously demonstrated to influence response to immune therapies in autoimmune epilepsy: (1) early initiation of immunotherapy (within 6 mo of diagnosis), (2) detection of an Ab reactive with the extracellular domain of a neural plasma membrane protein (cell‐surface antigen), which would indicate likely Ab pathogenicity.…”

Section: Methodsmentioning

confidence: 99%

“…A significant proportion of cryptogenic epilepsies has been attributed to autoimmunity, or a possible autoimmune cause (15–20%) . Establishing an autoimmune etiology has a large impact on management (immunotherapeutic in addition to standard anticonvulsants), and influences seizure outcomes . A recent, prospective study reported serologic findings among consecutively evaluated patients presenting with epilepsy of unknown etiology .…”

mentioning

confidence: 99%

Predictive models in the diagnosis and treatment of autoimmune epilepsy

et al. 2017

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“…Almost all patients require more than two conventional AEDs. Agents frequently employed include the following: benzodiazepines, levetiracetam, lacosamide, phenobarbital, phenytoin, topiramate, and valproate [41]. The newer AEDs, such as oxcarbazepine, levetiracetam, and lacosamide, may be superior to the older generation because of less drug-drug interaction and better tolerability [32,33].…”

Section: Treatment and Prognosismentioning

confidence: 99%

Paraneoplastic epilepsy

Serafini

Lukas

VanHaerents

et al. 2016

Epilepsy & Behavior

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Epilepsy can be a manifestation of paraneoplastic syndromes which are the consequence of an immune reaction to neuronal elements driven by an underlying malignancy affecting other organs and tissues. The antibodies commonly found in paraneoplastic encephalitis can be divided into two main groups depending on the target antigen: 1) antibodies against neuronal cell surface antigens, such as against neurotransmitter (N-methyl-d-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), gamma-aminobutyric acid (GABA)) receptors, ion channels (voltage-gated potassium channel (VGKC)), and channel-complex proteins (leucine rich, glioma inactivated-1 glycoprotein (LGI1) and contactin-associated protein-2 (CASPR2)) and 2) antibodies against intracellular neuronal antigens (Hu/antineuronal nuclear antibody-1 (ANNA-1), Ma2/Ta, glutamate decarboxylase 65 (GAD65), less frequently to CV2/collapsin response mediator protein 5 (CRMP5)). In this review, we provide a comprehensive survey of the current literature on paraneoplastic epilepsy indexed by the associated onconeuronal antibodies. While a range of seizure types can be seen with paraneoplastic syndromes, temporal lobe epilepsy is the most common because of the association with limbic encephalitis. Early treatment of the paraneoplastic syndrome with immune modulation/suppression may prevent the more serious potential consequences of paraneoplastic epilepsy.

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Retrospective case series of the clinical features, management and outcomes of patients with autoimmune epilepsy

Abstract: This study highlights certain important clinical and electrographic aspects of autoimmune epilepsy, and the significance of early diagnosis and initiation of immunomodulatory therapy.

Cited by 49 publications

References 18 publications

Refractory chronic epilepsy associated with neuronal auto‐antibodies: could perisylvian semiology be a clue?

Refractory chronic epilepsy associated with neuronal auto‐antibodies: could perisylvian semiology be a clue?

Predictive models in the diagnosis and treatment of autoimmune epilepsy

Paraneoplastic epilepsy

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