Searching for Autoimmune Epilepsy: Why, Where, and When?

Jehi, Lara

doi:10.5698/1535-7597.17.6.363

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…However, one should be wary when interpreting our results concerning the fact that some variables known to influence the white matter status could not be controlled for: patients after hemispherotomy may not necessarily have larger lesions, however, it may be guessed that they have a higher seizure burden (which ultimately lead to the indication for hemispherotomy) and a higher antiepileptic drug load, both thought to lower FA values (Jehi, 2017 ). In the hemispherotomy group, however, comparatively higher FA values have been found.…”

Section: Discussionmentioning

confidence: 99%

Contralesional White Matter Alterations in Patients After Hemispherotomy

Gaubatz

Prillwitz

Ernst

et al. 2020

Front. Hum. Neurosci.

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Cerebral lesions may cause degeneration and neuroplastic reorganization in both the ipsi-and the contralesional hemisphere, presumably creating an imbalance of primarily inhibitory interhemispheric influences produced via transcallosal pathways. The two hemispheres are thought to mutually hamper neuroplastic reorganization of the other hemisphere. The results of preceding degeneration and neuroplastic reorganization of white matter may be reflected by Diffusion Tensor Imaging-derived diffusivity parameters such as fractional anisotropy (FA). In this study, we applied Diffusion Tensor Imaging (DTI) to contrast the white matter status of the contralesional hemisphere of young lesioned brains with and without contralateral influences by comparing patients after hemispherotomy to those who had not undergone neurosurgery. DTI was applied to 43 healthy controls (26 females, mean age ± SD: 25.07 ± 11.33 years) and two groups of in total 51 epilepsy patients with comparable juvenile brain lesions (32 females, mean age ± SD: 25.69 ± 12.77 years) either after hemispherotomy (30 of 51 patients) or without neurosurgery (21 of 51 patients), respectively. FA values were compared between these groups using the unbiased tract-based spatial statistics approach. A voxel-wise ANCOVA controlling for age at scan yielded significant group differences in FA. A post hoc t-test between hemispherotomy patients and healthy controls revealed widespread supra-threshold voxels in the contralesional hemisphere of hemispherotomy patients indicating comparatively higher FA values (p < 0.05, FWE-corrected). The non-surgery group, in contrast, showed extensive supra-threshold voxels indicating lower FA values in the contralesional hemisphere as compared to healthy controls (p < 0.05, FWE-corrected). Whereas lower FA values are suggestive of pronounced contralesional degeneration in the non-surgery group, higher FA values in the hemispherotomy group may be interpreted as a result of preceding plastic remodeling. We conclude that, whether juvenile brain lesions are associated with contralesional degeneration or reorganization partly depends on the

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Section: Discussionmentioning

confidence: 99%

Contralesional White Matter Alterations in Patients After Hemispherotomy

Gaubatz

Prillwitz

Ernst

et al. 2020

Front. Hum. Neurosci.

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“…Although antibodies serve an important role as a biomarker for autoimmunemediated seizure disorders, in occasional cases, immunity is suspected based on clinical, imaging, and CSF results, but antibodies are absent. 16 In these cases, the possible presence of pathogenic autoantibodies that are not yet detectable by current techniques has been suggested by reports of such patients undergoing successful treatment with rituximab, 17 a medication that prevents differentiation of mature B cells into antibody-producing plasma cells. 18 Seronegative cases such as these provide evidence suggesting a broader role of immunity in clinical epilepsy and highlight the need to identify additional biomarkers to facilitate diagnosis.…”

Section: Pathophysiology and Diagnosismentioning

confidence: 99%

Autoimmune-Associated Seizures

Gillinder¹,

Britton²

2022

CONTINUUM: Lifelong Learning in Neurology

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“…It is now understood that antibodies can also be present in cases of epilepsy without other features of autoimmune encephalitis and that such individuals are poorly responsive to conventional antiseizure therapies [2]. As well as cases with known autoantibodies, there are cases that are seronegative on antibody testing but still benefit from immunotherapy [3]. This means there is a risk of refractory epilepsy patients with unrecognized autoimmunity remaining undiagnosed, resulting in a lost opportunity to have beneficial treatment, or the use of unnecessary interventions such as surgery [4].…”

mentioning

confidence: 99%

Effect of immunotherapy on intracranial EEG in patients with seronegative autoimmune‐associated epilepsy

Gillinder¹,

Papacostas²,

McCombe³

et al. 2022

Epileptic Disorders

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Objective. Immunity is increasingly implicated in the aetiology of certain types of epilepsy, however, the clinical and EEG features in such cases remain poorly defined. We present stereo‐electroencephalography (SEEG) findings in patients who were thought to have autoantibody‐mediated epilepsy on the basis of clinical improvement after administration of immunotherapy (IT). Methods. All patients undergoing SEEG implantation in our service were reviewed and those receiving immunotherapy, either before, during, or after SEEG evaluation, were identified. Response to immunotherapy was defined as greater than 50% seizure reduction. We compared the clinical features and SEEG findings between those who responded to immunotherapy and those who did not. Results. Sixty‐two cases underwent SEEG evaluation. Of these, 11 received immunotherapy and three cases demonstrated a positive clinical benefit. The three responsive patients had multifocal seizure onset, repetitive spiking interictally and ictally, perisylvian semiology, seizure onset in the posterior perisylvian regions, and normal neuroimaging. Significance. Seronegative immunotherapy responders exist in epilepsy populations, therefore the diagnosis of autoimmune‐associated epilepsy should be considered before proceeding to epilepsy surgery. Possible features of an electroclinical syndrome associated with autoimmunity may include multifocal seizure onset, perisylvian involvement, and normal neuroimaging.

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Searching for Autoimmune Epilepsy: Why, Where, and When?

Cited by 4 publications

References 9 publications

Contralesional White Matter Alterations in Patients After Hemispherotomy

Contralesional White Matter Alterations in Patients After Hemispherotomy

Autoimmune-Associated Seizures

Effect of immunotherapy on intracranial EEG in patients with seronegative autoimmune‐associated epilepsy

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