RT Journal Article
SR Electronic
T1 Epileptic phenotypes in autoimmune encephalitis: from acute symptomatic seizures to autoimmune-associated epilepsy
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP jnnp-2022-329195
DO 10.1136/jnnp-2022-329195
A1 Sara Matricardi
A1 Sara Casciato
A1 Silvia Bozzetti
A1 Sara Mariotto
A1 Andrea Stabile
A1 Elena Freri
A1 Francesco Deleo
A1 Stefano Sartori
A1 Margherita Nosadini
A1 Irene Pappalardo
A1 Stefano Meletti
A1 Giada Giovannini
A1 Elisabetta Zucchi
A1 Carlo Di Bonaventura
A1 Giancarlo Di Gennaro
A1 Sergio Ferrari
A1 Luigi Zuliani
A1 Marco Zoccarato
A1 Alberto Vogrig
A1 Simona Lattanzi
A1 Roberto Michelucci
A1 Antonio Gambardella
A1 Edoardo Ferlazzo
A1 Lucia Fusco
A1 Tiziana Granata
A1 Flavio Villani
A1 ,
YR 2022
UL http://jnnp.bmj.com/content/early/2022/07/25/jnnp-2022-329195.abstract
AB Objective To describe the clinical and paraclinical findings, treatment options and long-term outcomes in autoimmune encephalitis (AE), with a close look to epilepsy.Methods In this retrospective observational cohort study, we enrolled patients with new-onset seizures in the context of AE. We compared clinical and paraclinical findings in patients with and without evidence of antibodies.Results Overall, 263 patients (138 females; median age 55 years, range 4–86) were followed up for a median time of 30 months (range 12–120). Antineuronal antibodies were detected in 63.50%.Antibody-positive patients had multiple seizure types (p=0.01) and prevalent involvement of temporal regions (p=0.02). A higher prevalence of episodes of SE was found in the antibody-negative group (p<0.001).Immunotherapy was prescribed in 88.60%, and effective in 61.80%. Independent predictors of favourable outcome of the AE were early immunotherapy (p<0.001) and the detection of antineuronal surface antibodies (p=0.01).Autoimmune-associated epilepsy was the long-term sequela in 43.73%, associated with cognitive and psychiatric disturbances in 81.73%. Independent predictors of developing epilepsy were difficult to treat seizures at onset (p=0.04), a high number of antiseizure medications (p<0.001), persisting interictal epileptiform discharges at follow-up (p<0.001) and poor response to immunotherapy during the acute phase (p<0.001).Conclusions The recognition of seizures secondary to AE represents a rare chance for aetiology-driven seizures management. Early recognition and treatment at the pathogenic level may reduce the risk of long-term irreversible sequelae. However, the severity of seizures at onset is the major risk factor for the development of chronic epilepsy.This study provides class IV evidence for management recommendations.Data are available on reasonable request.