Clinical features and long-term outcomes of seizures associated with autoimmune encephalitis: A follow-up study in East China

Lu, Yen‐Shen; Wang, Yue; Wu, Xunyi; Wang, Jianhong; Zhu, Guangfa; Hong, Zhen

doi:10.1016/j.jocn.2019.07.049

Cited by 41 publications

(50 citation statements)

References 20 publications

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“…In our study, both patients with anti-GABA B R encephalitis had seizures, which manifested in two types: GTCS and MTLElike seizure, with status epilepticus; AEDs were ineffective, but immunotherapy was, which was in line with previous studies (2,5,6,8,13,(41)(42)(43). Previous studies have verified that severe and refractory seizures are the main features of anti-GABA B R encephalitis, as well as the initial and core symptoms, with incidence rate 90-100%.…”

Section: The Clinical and Eeg Features Of Seizures In Anti-gaba B R Esupporting

confidence: 90%

“…Previous studies have verified that severe and refractory seizures are the main features of anti-GABA B R encephalitis, as well as the initial and core symptoms, with incidence rate 90-100%. The common seizure types included focal seizure, FBTCS, and GTCS, with high frequency, and could rapidly progress to status epilepticus, and AEDs were ineffective (2,5,6,8,13,(41)(42)(43). There was correlation between seizures and disease activity (44).…”

Section: The Clinical and Eeg Features Of Seizures In Anti-gaba B R Ementioning

confidence: 99%

“…There are similar clinical characteristics between different subtypes of NSAb-associated AE with different antibodies, but each subtype has its own features in clinical manifestation, imaging, electroencephalogram (EEG), and incidence of tumor. Most patients with NSAb-associated AE have epileptic seizures in the acute or subacute phase of the disease or later during disease progression (5)(6)(7)(8), but little is known about the clinical and EEG features, treatment and prognosis of these seizures, as well as the risk of developing chronic epilepsy. In the present study, 18 cases with NSAb-associated AEs diagnosed in the First Affiliated Hospital of Dalian Medical University were collected and analyzed to investigate the clinical and EEG features of the seizures in different types of NSAb-associated AEs.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Electroencephalographic Features of the Seizures in Neuronal Surface Antibody-Associated Autoimmune Encephalitis

Wang

et al. 2020

Front. Neurol.

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Objectives: To investigate clinical and electroencephalographic features of the seizures in different types of neuronal surface antibody (NSAb)-associated autoimmune encephalitis (AE). Methods: The clinical data of the seizures were analyzed in 18 patients with NSAb-associated AEs diagnosed in the First Affiliated Hospital of Dalian Medical University. Results: From May 2013 to April 2019, a total of 18 cases of NSAb-associated AE were diagnosed, including 9 cases of leucine-rich glioma-inactivated 1 protein (LGI1) antibody-associated encephalitis, 7 cases of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis, and 2 cases of anti-γ-aminobutyric acid B receptor (GABA B R) encephalitis. All nine cases (100%) with LGI1 AE had seizures manifesting in three types: faciobranchial dystonia seizure (FBDS) (44.4%), mesial temporal lobe epilepsy (MTLE)-like seizure (66.7%), and focal to bilateral tonic-clonic seizure (FBTCS) (77.8%). Six of nine (66.7%) showed abnormal signal on hippocampus or basal ganglia in brain MRI. Five of seven cases (71%) with anti-NMDAR encephalitis had seizures manifesting in three types: focal aware seizure (40%), focal-impaired awareness seizure (20%), generalized tonic-clonic seizure (GTCS) (100%), and status epilepticus (SE) (40%). Three of seven (42.8%) showed abnormalities in brain MRI. Both patients with anti-GABA B R encephalitis had seizures manifesting in two types: GTCS and MTLE-like seizure, one with SE. One showed abnormal signal on left hippocampus in brain MRI. All patients (100%) with three types of AE had abnormalities in electroencephalogram (EEG), showing diffuse (4/18) or focal slow waves (14/18) in background, interictal (10/18), or ictal (6/18) epileptic discharges in the temporal or other regions; two patients with anti-NMDAR encephalitis showed delta activity or rhythm in frontotemporal region. All patients with seizures showed good response to immunotherapy except one with LGI1 AE. Conclusions: Most patients with NSAb-associated AE had seizures; seizure types varied between different types of AE. In LGI1 AE, the hippocampus and basal ganglia were two main targets; the corresponding seizure type was MTLE-like seizure and FBDS, respectively. Anti-NMDAR encephalitis had more generalized than focal seizures. Wang et al. Seizure Features in Autoimmune Encephalitis Delta activity or rhythm in the frontotemporal region in EEG was helpful for diagnosis. Anti-GABA B R encephalitis was characterized by refractory seizures as initial symptom, mainly GTCS or MTLE-like seizure. Most seizures in NSAb-associated AE showed good response to immunotherapy, and antiepileptic drugs should be considered as an add-on symptomatic treatment.

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Section: The Clinical and Eeg Features Of Seizures In Anti-gaba B R Esupporting

confidence: 90%

Section: The Clinical and Eeg Features Of Seizures In Anti-gaba B R Ementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical and Electroencephalographic Features of the Seizures in Neuronal Surface Antibody-Associated Autoimmune Encephalitis

Wang

et al. 2020

Front. Neurol.

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“…The difference in the proportion of patients with seizure remission between the normal and abnormal MRI groups was not statistically significant. Previous studies indicated that anti‐NMDAR encephalitis‐associated seizures were successfully treated with immunotherapy and antiepileptics, and most do not require long‐term antiepileptic medication 5,6,24 . In the context of anti‐NMDAR encephalitis, the development of seizures and status epilepticus usually represents an acute, symptomatic manifestation of the brain inflammatory process, but the risk of the development of chronic epilepsy is relatively low.…”

Section: Discussionmentioning

confidence: 99%

Associations between seizures and MRI in patients with anti‐NMDAR encephalitis

Lin

Cai

et al. 2020

Acta Neurol Scand

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Objectives: Seizures are a prominent feature of anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. Nearly half of brain magnetic resonance image (MRI) results are abnormal. The aim of our study was to evaluate the associations between seizures and brain MRI results in patients with anti-NMDAR encephalitis. Methods: Patients with anti-NMDAR encephalitis were enrolled between January 2015 and December 2018. The patients included were divided into normal and abnormal MRI groups. Seizure outcomes and modified Rankin Scale scores at the 1-year follow-up were assessed. Seizure characteristics and outcomes were compared between groups. Results: Of 35 patients with anti-NMDAR encephalitis, 28 patients (80%) had reported seizures in the acute phase. Patients with abnormal MRI findings more frequently had focal seizures than patients with normal MRI findings (72.7% vs 17.6%, P < .01). The incidence of patients treated with 2 or more antiepileptic drugs was higher in the normal MRI group than in the abnormal MRI group (100% vs 45.4%, P < .01). The onset-immunotherapy time was shorter in the abnormal MRI group than in the normal MRI group (P < .05). There were no statistically significant differences in seizure outcomes between the normal and abnormal MRI groups (P > .05). Conclusions: Focal seizures were most common in patients with abnormal MRI lesions. In the acute stage of the disease, the abnormal MRI group was more likely than the normal MRI group to achieve seizure control. Abnormal MRI findings did not affect the overall good prognosis of patients with anti-NMDAR encephalitis with seizures.

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“…6 In fact, studies have found that the probability of seizure occurrence after the acute phase is not much high in AIE patients who reported seizures. 7,8 Titulaer et al's study also indicated that seizures in AIE tend to resolve faster and more frequently after immunotherapy, suggesting AEDs could be considered as add-on treatment, unlike in epilepsy. 9 Thus, it is of great interest to find out potential factors predictive of seizure outcomes and identify the duration of AEDs use in AIE patients.…”

Section: Introductionmentioning

confidence: 99%

Seizures and risk of epilepsy in anti‐NMDAR, anti‐LGI1, and anti‐GABA_BR encephalitis

Shen

Fang

Yang

et al. 2020

Ann Clin Transl Neurol

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Background Accumulating data have suggested seizures occur frequently in patients with neuronal surface antibody‐mediated autoimmune encephalitis. We aimed to evaluate seizure outcomes and potential factors associated with the development of epilepsy in patients with anti‐N‐methyl‐D‐aspartate receptor (NMDAR), anti‐leucine‐rich glioma‐inactivated 1 (LGI1), and anti‐gamma‐aminobutyric‐acid B receptor (GABABR) encephalitis. Methods Patients with anti‐NMDAR, anti‐LGI1, and anti‐GABABR encephalitis were prospectively recruited from 2014 to June 2019, with a median follow‐up period of 30.5 months (range 8–67 months). Seizure outcomes were assessed and risk factors of epilepsy were analyzed. Results A total of 119 patients with anti‐NMDAR, anti‐LGI1, and anti‐GABABR encephalitis were included, and 83 (69.7%) of them developed new‐onset seizures. By the end of follow‐up, 17 (21.3%) of 80 patients had seizure relapses after intermittent seizure remission or exhibited uncontrolled seizure episodes, contributing to epilepsy. Immunotherapy delay and interictal epileptic discharges (IEDs) were identified to be associated with the development of epilepsy in patients with anti‐NMDAR, anti‐LGI1, and anti‐GABABR encephalitis, particularly anti‐NMDAR encephalitis. Furthermore, multivariate logistic regression analysis demonstrated that immunotherapy delay was an independent predictor for epilepsy. Conclusion Our study suggested that immunotherapy delay and IEDs were associated with the development of epilepsy in patients with anti‐NMDAR, anti‐LGI1, and anti‐GABABR encephalitis. Early diagnosis and treatment were required, and particular consideration should be given to patients with these risk factors.

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Clinical features and long-term outcomes of seizures associated with autoimmune encephalitis: A follow-up study in East China

Cited by 41 publications

References 20 publications

Clinical and Electroencephalographic Features of the Seizures in Neuronal Surface Antibody-Associated Autoimmune Encephalitis

Clinical and Electroencephalographic Features of the Seizures in Neuronal Surface Antibody-Associated Autoimmune Encephalitis

Associations between seizures and MRI in patients with anti‐NMDAR encephalitis

Seizures and risk of epilepsy in anti‐NMDAR, anti‐LGI1, and anti‐GABA_BR encephalitis

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Clinical features and long-term outcomes of seizures associated with autoimmune encephalitis: A follow-up study in East China

Cited by 41 publications

References 20 publications

Clinical and Electroencephalographic Features of the Seizures in Neuronal Surface Antibody-Associated Autoimmune Encephalitis

Clinical and Electroencephalographic Features of the Seizures in Neuronal Surface Antibody-Associated Autoimmune Encephalitis

Associations between seizures and MRI in patients with anti‐NMDAR encephalitis

Seizures and risk of epilepsy in anti‐NMDAR, anti‐LGI1, and anti‐GABABR encephalitis

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Product

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About

Seizures and risk of epilepsy in anti‐NMDAR, anti‐LGI1, and anti‐GABA_BR encephalitis