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Research paper
Neuronal autoantibodies in mesial temporal lobe epilepsy with hippocampal sclerosis
  1. Ebru Nur Vanli-Yavuz1,2,
  2. Ece Erdag3,
  3. Erdem Tuzun3,
  4. Esme Ekizoglu1,3,
  5. Leyla Baysal-Kirac1,
  6. Canan Ulusoy3,
  7. Sian Peach4,
  8. Gokcen Gundogdu5,
  9. Serra Sencer6,
  10. Altay Sencer7,
  11. Cem Ismail Kucukali3,
  12. Nerses Bebek1,
  13. Candan Gurses1,
  14. Aysen Gokyigit1,
  15. Betul Baykan1
  1. 1Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
  2. 2Department of Neurology, Koc University, School of Medicine, Istanbul, Turkey
  3. 3Department of Neuroscience, Istanbul University, Institute of Experimental Medical Research, Istanbul, Turkey
  4. 4Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
  5. 5Istanbul Faculty of Medicine, Department of Pathology, Istanbul University, Istanbul, Turkey
  6. 6Istanbul Faculty of Medicine, Department of Neuroradiology, Istanbul University, Istanbul, Turkey
  7. 7Istanbul Faculty of Medicine, Department of Neurosurgery, Istanbul University, Istanbul, Turkey
  1. Correspondence to Dr Ebru Nur Vanli-Yavuz, Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, 34093 Capa/Fatih/Istanbul, Turkey; ebruvanli{at}gmail.com

Abstract

Objective Our aim was to investigate the prevalence of neuronal autoantibodies (NAbs) in a large consecutive series with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and to elucidate the clinical and laboratory clues for detection of NAbs in this prototype of frequent, drug-resistant epilepsy syndrome.

Methods Consecutive patients diagnosed with MTLE fulfilling the MRI criteria for HS were enrolled. The sera of patients and various control groups (80 subjects) were tested for eight NAbs after ethical approval and signed consents. Brain tissues obtained from surgical specimens were also investigated by immunohistochemical analysis for the presence of inflammatory infiltrates. The features of seropositive versus seronegative groups were compared and binary logistic regression analysis was performed to explore the differentiating variables.

Results We found antibodies against antigens, contactin-associated protein-like 2 in 11 patients, uncharacterised voltage-gated potassium channel (VGKC)-complex antigens in four patients, glycine receptor (GLY-R) in 5 patients, N-methyl-d-aspartate receptor in 4 patients and γ-aminobutyric acid receptor A in 1 patient of 111 patients with MTLE-HS and none of the control subjects. The history of status epilepticus, diagnosis of psychosis and positron emission tomography or single-photon emission CT findings in temporal plus extratemporal regions were found significantly more frequently in the seropositive group. Binary logistic regression analysis disclosed that status epilepticus, psychosis and cognitive dysfunction were statistically significant variables to differentiate between the VGKC-complex subgroup versus seronegative group.

Conclusions This first systematic screening study of various NAbs showed 22.5% seropositivity belonging mostly to VGKC-complex antibodies in a large consecutive series of patients with MTLE-HS. Our results indicated a VGKC-complex autoimmunity-related subgroup in the syndrome of MTLE-HS.

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