Acute Symptomatic Seizures and Risk of Epilepsy in Autoimmune Encephalitis: A Retrospective Cohort Study

Zhong, Rui; Zhang, Xinyue; Chen, Qingling; Li, Mengmeng; Guo, Xin; Lin, Weihong

doi:10.3389/fimmu.2022.813174

Cited by 10 publications

(17 citation statements)

References 23 publications

(59 reference statements)

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“…Qiao et al 10.3389/fimmu.2022.986853 nonepileptic seizure is widely debated. Recently, some researchers detected generalized EEG electrodecremental events, and others found typical focal contralateral frontal waves, both preceding the onset of muscle artifacts, indicating that FBDS were atypical seizures (15).…”

Section: Discussionmentioning

confidence: 99%

“…Subacute onset of cognitive dysfunction and psychiatric symptoms has been demonstrated in most cases of anti-LGI1 encephalitis (7,8). Seizures occur in more than 85% of patients who suffer from anti-LGI-1 encephalitis and can be the initial, primary, or in rare cases the sole manifestation of the disease (9,10). FBDS as a subtype of seizures was deemed to be a characteristic symptom of anti-LGI1 encephalitis (7,11).…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Paroxysmal hyperhidrosis as an initial symptom in a patient with anti-LGI1 encephalitis

et al. 2022

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Anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis is the second most common cause of autoimmune encephalitis and is characterized by cognitive impairment, psychiatric disorders, and faciobrachial dystonic seizures. In recent decades, literature reports have expanded the phenotypic spectrum associated with the LGI1 autoantibody. The present report describes the case of a 58-year-old man who presented with repetitive unilateral hyperhidrosis of the body and arm as an initial symptom and gradually developed psychiatric symptoms, involuntary movements of the face and arms, and progressive cognitive decline. Anti-LGI1 antibodies were positive in both the serum and cerebrospinal fluid at approximately 2 months after symptom onset, and the patient was, therefore, diagnosed with anti-LGI1 encephalitis. His symptoms, namely hyperhidrosis and involuntary movements, were not relieved by antiepileptic drug treatment, but responded favorably to high-dose steroid therapy and intravenous immunoglobulin. We interpreted the repetitive unilateral hyperhidrosis as possible epilepsy. Based on this case, unilateral hyperhidrosis of the body and arm as a rare neurological presentation can be added to the phenotypic spectrum of anti-LGI1 encephalitis, and early recognition of this manifestation might support timely diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Case Report: Paroxysmal hyperhidrosis as an initial symptom in a patient with anti-LGI1 encephalitis

et al. 2022

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“…Then, 1,198 articles were excluded after screening the titles and abstracts, leaving 168 articles with full text available. Eventually, 10 studies were included in the meta-analysis (6,11,12,16,(19)(20)(21)(22)(23)(24) (Figure 1). Nine were retrospective cohort studies, and one was a prospective cohort study; the follow-up time ranged from 7.16 to 48 months, and the sample size ranged from 19 to 111 individuals.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Seizure outcome-related factors in autoimmune encephalitis: A systematic review and meta-analysis

et al. 2022

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BackgroundIdentifying the predictors for seizure outcome in autoimmune encephalitis (AE) and investigating how to prevent persistent seizures would have major clinical benefits effectively. Thus, we aimed to perform a systematic review and meta-analysis to examine seizure outcome-related factors in AE patients.MethodsPubMed and EMBASE were systematically searched from inception to 10 June 2022 for studies investigating seizure outcome-related factors in AE. The pooled effect estimates, including standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs), were calculated to estimate the effect of each included factor on the seizure outcome.ResultsA total of 10 studies were included in the meta-analysis. Our pooled results of this meta-analysis showed that five factors were found to increase the risk of persistent seizures in AE patients, including onset with seizures (OR = 2.106, 95% CI = 1.262–3.514, p = 0.004), status epilepticus (OR = 3.017, 95% CI = 1.995–4.563, p < 0.001), EEG abnormalities (OR = 1.581, 95% CI = 1.016–2.46, p = 0.042), MRI abnormalities (OR = 1.554, 95% CI = 1.044–2.283, p = 0.03), and longer time from clinical onset to immunotherapy (SMD = 1.887, 95% CI = 0.598–3.156, p = 0.004).ConclusionOur meta-analysis indicated that onset with seizures, status epilepticus, EEG abnormalities, MRI abnormalities, and longer time from clinical onset to immunotherapy were risk factors for persistent seizures in AE patients.

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“…However, the term of “autoimmune epilepsy” has been challenged because many patients with the NSAbs‐mediated encephalitis could experience complete seizure freedoms and ultimately terminate anti‐seizure medications (ASMs) in the acute phase of disease 9,10 . Certainly, a minority of patients (10%–28%) may eventually develop chronic epilepsy due to an enduring predisposition to unprovoked seizures 11,12 . To clarify the relationship between seizures or epilepsy and autoimmune encephalitis, the terms of “acute symptomatic seizures (ASS) secondary to autoimmune encephalitis” and “autoimmune‐associated epilepsy (AAE)” were proposed by International League Against Epilepsy (ILAE) in 2020, 13 which was highly important to early differentiate ASS from epilepsy because the former mainly respond better to immunotherapy rather than anti‐seizure medications 14 .…”

Section: Introductionmentioning

confidence: 99%

“… 9 , 10 Certainly, a minority of patients (10%–28%) may eventually develop chronic epilepsy due to an enduring predisposition to unprovoked seizures. 11 , 12 To clarify the relationship between seizures or epilepsy and autoimmune encephalitis, the terms of “acute symptomatic seizures (ASS) secondary to autoimmune encephalitis” and “autoimmune‐associated epilepsy (AAE)” were proposed by International League Against Epilepsy (ILAE) in 2020, 13 which was highly important to early differentiate ASS from epilepsy because the former mainly respond better to immunotherapy rather than anti‐seizure medications. 14 In addition, the early identification and intervention of autoimmune etiology in patients with ASS may avoid the formation of chronic epilepsy and long‐term application of ASMs.…”

Section: Introductionmentioning

confidence: 99%

Factors predicting neuronal surface antibodies in the elderly with new‐onset and unknown seizures

Liu

et al. 2022

Ann Clin Transl Neurol

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Objective To investigate risk factors of neuronal surface antibodies (NSAbs) and develop a nomogram that could identify patients at the odds of NSAbs among the elderly (aged 60 years or older) with new‐onset seizures of unknown etiology. Methods Clinical data for aged ≥60 years diagnosed with new‐onset seizures of unknown etiology were retrospectively reviewed. A nomogram based on multivariable logistic regression was constructed. Model performance of nomogram was evaluated using area under the curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC). Meanwhile, it was internally validated by bootstrap validation in current cohort. Results Of 147 patients included in final analysis, 68 (46.3%) had NSAbs‐mediated encephalitis. Six factors were identified: duration of seizures less than 3 months (OR:14.259; 95% CI: 4.480–45.386), focal‐onset seizures (OR:12.457; 95% CI: 2.710–57.261), psychiatric deficits (OR:10.063; 95% CI: 3.231–31.343), sleep disorders (OR:3.091; 95% CI: 1.011–9.454), hyponatremia (OR:6.252; 95% CI: 1.445–27.043), and medial temporal lobe (MTL) lesions on MRI (OR:4.102; 95% CI: 1.382–12.169). The nomogram had a good discrimination with an AUC of 0.916 and with a corrected AUC of 0.881 after the bootstrapping validation, our model also exhibited a better predictive performance than scoring systems commonly used clinically. Additionally, the calibration curve showed that predicted NSAbs‐positive rates of nomogram were closely aligned with actual observed results. Moreover, the nomogram achieved well on clinical utility by using the DCA and CIC. Interpretation Our nomogram may provide a convenient and useful tool for identifying the elderly with new‐onset seizures of unknown etiology who are at risk of NSAbs‐mediated encephalitis, which would allow these patients receive earlier immunotherapy.

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Acute Symptomatic Seizures and Risk of Epilepsy in Autoimmune Encephalitis: A Retrospective Cohort Study

Cited by 10 publications

References 23 publications

Case Report: Paroxysmal hyperhidrosis as an initial symptom in a patient with anti-LGI1 encephalitis

Case Report: Paroxysmal hyperhidrosis as an initial symptom in a patient with anti-LGI1 encephalitis

Seizure outcome-related factors in autoimmune encephalitis: A systematic review and meta-analysis

Factors predicting neuronal surface antibodies in the elderly with new‐onset and unknown seizures

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