Epileptic phenotypes in autoimmune encephalitis: from acute symptomatic seizures to autoimmune-associated epilepsy. Issue 11 (25th July 2022)

• Record Type: Journal Article
• Authors: Matricardi, Sara; Casciato, Sara; Bozzetti, Silvia; Mariotto, Sara; Stabile, Andrea; Freri, Elena; Deleo, Francesco; Sartori, Stefano; Nosadini, Margherita; Pappalardo, Irene; Meletti, Stefano; Giovannini, Giada; Zucchi, Elisabetta; Di Bonaventura, Carlo; Di Gennaro, Giancarlo; Ferrari, Sergio; Zuliani, Luigi; Zoccarato, Marco; Vogrig, Alberto; Lattanzi, Simona; Michelucci, Roberto; Gambardella, Antonio; Ferlazzo, Edoardo; Fusco, Lucia; Granata, Tiziana; Villani, Flavio
• Other Names: author non-byline.; Aguglia Umberto author non-byline.; Belcastro Vincenzo author non-byline.; Benedetti Luana author non-byline.; Beretta Simone author non-byline.; Bova Stefania Maria author non-byline.; Cagnetti Claudia author non-byline.; Casellato Susanna author non-byline.; Celli Lorenzo author non-byline.; Cesaroni Elisabetta author non-byline.; Cesnick Eduard author non-byline.; Coppola Giangennaro author non-byline.; Correnti Edvige author non-byline.; Didato Giuseppe author non-byline.; D'Orsi Giuseppe author non-byline.; Fallica Elena author non-byline.; Ferrari Alessandra author non-byline.; Ferretti Alessandro author non-byline.; Galimberti Carlo Andrea author non-byline.; Giallonardo Annateresa author non-byline.; Giuliano Loretta author non-byline.; Neve Angela La author non-byline.; Liguori Claudio author non-byline.; Marini Carla author non-byline.; Massa Federico author non-byline.; Mastrangelo Massimo author non-byline.; Mumoli Laura author non-byline.; Mutti Carlotta author non-byline.; Operto Francesca Felicia author non-byline.; Pasini Elena author non-byline.; Pastori Chiara author non-byline.; Passarelli Daniela author non-byline.; Pauletto Giada author non-byline.; Pizzanelli Chiara author non-byline.; Ragona Francesca author non-byline.; Riguzzi Patrizia author non-byline.; Rizzi Romana author non-byline.; Santarone Marta Elena author non-byline.; Simula Delia author non-byline.; Sofia Vito author non-byline.; Tappatà Maria author non-byline.; Tartara Elena author non-byline.; Vanadia Francesca author non-byline.; Verrotti Alberto author non-byline.; Tassi Laura author non-byline.; Zinno Lucia author non-byline.;
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 93:Issue 11(2022)
• Page Start: 1194
• Page End: 1201
• Publication Date: 2022-07-25
• Subjects: EPILEPSY -- AUTOIMMUNE ENCEPHALITIS; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2022-329195
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : 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.