Application of the APE2-CHN and RITE2-CHN scores for autoimmune seizures and epilepsy in Chinese patients: A retrospective study. (October 2020)

• Record Type: Journal Article
• Authors: Liu, Wei-ping; Wang, Mian; Zhang, Chen; Zhao, Charlie W.; Xiao, Bo; Zeng, Chang
• Is Part Of: Seizure. Volume 81(2020)
• Page Start: 63
• Page End: 70
• Publication Date: 2020-10
• Subjects: Autoimmune seizures -- Diagnosis -- Immunotherapy; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2020.07.021
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: The most prevalent neural-specific antibodies detected in our sampling of Chinse patients with seizures or epilepsy of unknown etiology were NMDAR, GABABR, and MOG. An APE 2 -CHN score ≥ 5 had 85.5 % sensitivity and 58.9 % specificity in predicting autoantibody positivity. A RITE 2 -CHN score ≥ 8 had 98.6 % sensitivity and 83.8 % specificity in predicting positive outcomes in seizure control. Abstract: Purpose: To assess the performance of the Antibody Prevalence in Chinese Patients with Epilepsy and Encephalopathy (APE 2 -CHN) and Response to Immunotherapy in Chinese Patients with Epilepsy and Encephalopathy (RITE 2 -CHN) scores in Chinese patients with epilepsy of unknown etiology. Methods: We conducted a retrospective study of selected patients from Xiangya Hospital, Central South University (01/01/2017-02/28/2019) whose serum and/or cerebrospinal fluid (CSF) samples were examined for autoimmune encephalitis antibodies. Of these, patients with diagnostic code of seizure or epilepsy were selected in our study. An APE 2 -CHN score was assigned to each patient and a RITE 2 -CHN score was calculated for each patient who received immunotherapy. Receiver-operating characteristic (ROC) curve was used to assess each score. Results: 191 patients were enrolled in our study. 36 were identified with specific etiologies. The remaining 155 patients had unknown etiology. Central nervous system-specific antibodies were detected in 76 (49.0 %) patients, after excluding patients with only anti-thyroid peroxidase or glutamic acid decarboxylase antibodies. N-methyl-d -aspartate receptor (NMDAR) antibody (48.7 %, 37/76) was the most common subtype of our sample, followed by γ-aminobutyric acid type B receptor (GABAR) (14.5 %, 11/76). Clinical features including new-onset epilepsy, neuropsychiatric changes, speech disorder, movement disorder and inflammatory CSF profile correlated with positive antibody results. The sensitivity and specificity of APE 2 -CHN ≥ 5 in predicting the presence of neural-specific autoantibodies in our study were 85.5 % and 58.9 % respectively. In the subset of patients who received immunotherapy (n = 112), sensitivity and specificity of a RITE 2 -CHN ≥ 8 in predicting favorable seizure outcome were 98.6 % and 63.2 % respectively. The area under the curve (AUC) of RITE 2 -CHN was greater than that of RITE 2 (Z = 3.196, p < 0.05) while there was no significant difference in AUC between APE 2 and APE 2 -CHN (Z = 1.058, p = 0.290). Conclusion: The APE 2 -CHN and RITE 2 -CHN scores may be useful screening tools in predicting positive antibody findings and prognosis of suspected autoimmune seizures or associated epilepsy in the Chinese population.