Proposal of a diagnostic algorithm for autoimmune epilepsy: preliminary investigation of its utility

Sakamoto, Munenori; Matsumoto, Riki; Togawa, Jumpei; Hashi, Yuichiro; Takeyama, Hirofumi; Kobayashi, Katsuya; Shimotake, Akihiro; Kondo, Takayuki; Takahashi, Ryōsuke; Ito, Akio

doi:10.5692/clinicalneurol.cn-001180

Cited by 2 publications

(4 citation statements)

References 22 publications

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“…Recent advancements in AGID research show that the conventional concept of neurogastroenterology is not sufficient for defining AGID, as AGID is now known to encompass both neurogastroenterology and clinical immunology ( Figure 5). Autoimmune neurology, which focuses on antibody-mediated autoimmune diseases including autoimmune encephalitis, autoimmune epilepsy, and autoimmune psychosis, is one of the most rapidly evolving fields in modern neurology [93][94][95][96]. AGID should also be investigated as extensively as the abovementioned diseases, which will require cooperation among specialists, especially clinical immunologists, gastroenterologists, and neurologists.…”

Section: Concluding Remarks and Future Perspectivesmentioning

confidence: 99%

Autoimmune gastrointestinal dysmotility: the interface between clinical immunology and neurogastroenterology

Nakane

Mukaino

Ihara

et al. 2020

Immunological Medicine

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Autoimmune gastrointestinal dysmotility (AGID), an idiopathic or paraneoplastic phenomenon, is a clinical form of limited autoimmune dysautonomia. The symptoms of AGID and gastrointestinal manifestations in patients with autoimmune rheumatic diseases are overlapping. Antineuronal autoantibodies are often detected in patients with AGID. Autoantibodies play a key role in GI dysmotility; however, whether they cause neuronal destruction is unknown. Hence, the connection between the presence of these autoantibodies and the specific interference in synaptic transmission in the plexus ganglia of the enteric nervous system has to be determined. The treatment options for AGID are not well-defined. However, theoretically, immunomodulatory therapies have been shown to be effective and are therefore used as the first line of treatment. Nonetheless, diverse combined immunomodulatory therapies should be considered for intractable cases of AGID. We recommend comprehensive autoimmune evaluation and cancer screening for clinical diagnosis of AGID. Univocal diagnostic criteria, treatment protocols, and outcome definitions for AGID are required for prompt diagnosis and treatment and appropriate management of immunotherapy, which will circumvent the need for surgeries and improve patient outcome. In conclusion, AGID, a disease at the interface of clinical immunology and neurogastroenterology, requires further investigations and warrants cooperation among specialists, especially clinical immunologists, gastroenterologists, and neurologists.

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Section: Concluding Remarks and Future Perspectivesmentioning

confidence: 99%

Autoimmune gastrointestinal dysmotility: the interface between clinical immunology and neurogastroenterology

Nakane

Mukaino

Ihara

et al. 2020

Immunological Medicine

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show abstract

“…The use of this algorithm showed the possibility of diagnosing autoimmune epilepsy without waiting for the results of antineuronal antibody testing when patients have clinical features suggestive of autoimmune epilepsy and laboratory examination results indicating two or more positive findings (groups A, B, and C). Compared with the preliminary study ( 11 ), the revised algorithm had higher sensitivity, and the use of immunohistochemistry improved the accuracy of the diagnosis of autoimmune epilepsy.…”

Section: Discussionmentioning

confidence: 92%

“…All patients were admitted to the hospital from January 2012 to March 2017, and underwent comprehensive evaluations for epilepsy. We included 40 out of 70 patients from the preliminary cohort ( 11 ) whose serum or CSF samples were available to check the rat brain immunohistochemistry and comprehensive antibody testing, and added 20 patients who were admitted after the previous study had been completed. When patients had other obvious neurological diseases, such as paraneoplastic neurological syndrome and multiple sclerosis (MS), they were excluded from the present study.…”

Section: Methodsmentioning

confidence: 99%

“…In a real-world clinical environment, the medical history is first assessed, followed by laboratory tests, evaluation of these test results, and the final diagnosis. We previously proposed such a diagnostic algorithm for autoimmune epilepsy and evaluated its clinical utility ( 11 ). In this preliminary investigation, the diagnostic algorithm followed the “real-world” practical procedures, from assessing medical history/clinical symptoms to laboratory examinations, taking into account the “clinical features suggesting autoimmune epilepsy” ( 7 ).…”

Section: Methodsmentioning

confidence: 99%

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Diagnostic value of an algorithm for autoimmune epilepsy in a retrospective cohort

et al. 2022

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PurposeThis study aims to propose a diagnostic algorithm for autoimmune epilepsy in a retrospective cohort and investigate its clinical utility.MethodsWe reviewed 60 patients with focal epilepsy with a suspected autoimmune etiology according to board-certified neurologists and epileptologists. To assess the involvement of the autoimmune etiology, we used the patients' sera or cerebrospinal fluid (CSF) samples to screen for antineuronal antibodies using rat brain immunohistochemistry. Positive samples were analyzed for known antineuronal antibodies. The algorithm applied to assess the data of all patients consisted of two steps: evaluation of clinical features suggesting autoimmune epilepsy and evaluation using laboratory and imaging findings (abnormal CSF findings, hypermetabolism on fluorodeoxyglucose-positron emission tomography, magnetic resonance imaging abnormalities, and bilateral epileptiform discharges on electroencephalography). Patients were screened during the first step and classified into five groups according to the number of abnormal laboratory findings. The significant cutoff point of the algorithm was assessed using a receiver-operating characteristic curve analysis.ResultsFourteen of the 60 patients (23.3%) were seropositive for antineuronal antibodies using rat brain immunohistochemistry. Ten patients had antibodies related to autoimmune epilepsy/encephalitis. The cutoff analysis of the number of abnormal laboratory and imaging findings showed that the best cutoff point was two abnormal findings, which yielded a sensitivity of 78.6%, a specificity of 76.1%, and an area under the curve of 0.81.ConclusionThe proposed algorithm could help predict the underlying autoimmune etiology of epilepsy before antineuronal antibody test results are available.

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Proposal of a diagnostic algorithm for autoimmune epilepsy: preliminary investigation of its utility

Cited by 2 publications

References 22 publications

Autoimmune gastrointestinal dysmotility: the interface between clinical immunology and neurogastroenterology

Autoimmune gastrointestinal dysmotility: the interface between clinical immunology and neurogastroenterology

Diagnostic value of an algorithm for autoimmune epilepsy in a retrospective cohort

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