Seizure specificities in patients with antibody‐mediated autoimmune encephalitis

Abstract

Accumulating data on patients with autoimmune encephalitis have shed light on specificities concerning clinical presentation and outcomes, which are dependent on the antigen targeted by the autoantibodies found in the patients’ cerebrospinal fluid or sera. Such specificities include seizure‐related clinical manifestations as well as the responsiveness to antiepileptic drugs. Although increased enthusiasm accompanies the discovery of novel antibodies and their associated clinical syndromes, several issues remain unsettled. First, it appears that therapy needs to be personalized in the view of the severity of each antibody‐mediated syndrome, patient‐related characteristics, and timing of treatment. Second, the lack of randomized controlled trials is a major drawback in the formulation of an appropriate immunotherapeutic strategy. In this review, we discuss the novel developments and challenges for the diagnosis and treatment of epilepsy in patients with well‐characterized autoimmune encephalitis, and delineate the principles for a rational approach toward precision medicine in this emerging field.

Seizures and risk of epilepsy in anti‐NMDAR, anti‐LGI1, and anti‐GABABR encephalitis

“…15 As seizure was one of the core symptoms of AIE, it is vital to distinguish "acute seizures" from "autoimmune epilepsy," which was defined as the "epilepsy" resulted directly from an immune disorder. 16,17 According to the definition of epilepsy mentioned above, our data showed that 21.3% patients with anti-NMDAR, anti-LGI1, and anti-GABA B R encephalitis may contribute to autoimmune epilepsy, and patients with anti-NMDA encephalitis described the similar probability. The proportion was in keeping with Liu et al's study, 7 in which 109 cases with anti-NMDAR encephalitis were enrolled, showing more than 80% of the whole cohort with acute seizures had their last seizure within 6 months from disease onset.…”

Associations between HLA and autoimmune neurological diseases with autoantibodies

“…Interestingly, B*57:01 and C*06:02, which are known to be linked respectively to antibiotic-induced rash and psoriasis, were detected in patients presenting with these comorbidities [86]. Although cutaneous reactions related to antiepileptic drugs are a major concern in anti-LGI1 LE [87], no HLA associations have been yet described in this subgroup of patients [86].…”

Long-term Outcomes of Patients with Anti–Leucine-Rich Glioma-Inactivated 1 Encephalitis

“…In the last few decades, the eld of autoimmune epilepsy has received increasing attention with the discovery of different subtypes of neural autoantibodies. 5,[16][17][18][19] In the latest 2017 epilepsy classi cation, autoimmune epilepsy has been recognized as a distinct entity by the International League Against Epilepsy. 20 Most patients with autoimmune epilepsy present with seizures, cognitive decline, and behavioral or psychiatric dysfunction.…”