The Different Clinical Features Between Autoimmune and Infectious Status Epilepticus

Abstract

Objective: The prognosis of status epilepticus (SE) is highly related to the underlying etiology. Inflammation of the central nervous system (CNS), including infection and autoimmune encephalitis, is one of the treatable conditions causing SE. The initial presentation of infectious and autoimmune CNS disorders can be quite similar, which may be difficult to differentiate at the beginning. However, treatment for these entities can be quite different. In this study, we aim to identify the differences in clinical features among patients with infectious and autoimmune SE, which could help the clinicians to select initial investigation and ensuing therapies that may improve overall outcomes. Methods: This was a retrospective study that included 501 patients with SE within a period of 10.5-years. Patients with inflammatory etiology were collected and separated into infectious and autoimmune SE. The symptoms at onset, SE semiology, status epilepticus severity score, and END-IT score at admission, treatment for SE, and outcome (modified Rankin Scale) on discharge and last follow-up were recorded. Data on the first cerebrospinal fluid, electroencephalography, and magnetic resonance imaging were also collected. Results: Forty-six (9.2%) of the 501 patients had SE with inflammatory etiology. Twenty-five (5%) patients were autoimmune SE and 21 (4.2%) were infectious SE. Patients with autoimmune SE have younger age and female predominance. As for clinical presentations, psychosis, non-convulsive SE, and super refractory SE were more common in patients with autoimmune SE. Nevertheless, the prognosis showed no difference between the two groups. Conclusion: The different initial clinical presentations and patient characteristics may provide some clues about the underlying etiology of SE. When inflammatory etiology is suspected in patients with SE, younger age, female sex, psychosis, non-convulsive SE, and super refractory SE are clinical features that suggest an autoimmune etiology.

Predicting the Functional Outcome of Adult Patients with Status Epilepticus

“…Moreover, in the founding study of END-IT, 91.5% of the encephalitis group had infectious encephalitis [6]. However, autoimmune encephalitis had emerged as an important etiology of SE recently [17] and several studies including ours have shown that infectious and autoimmune encephalitis have similar prevalence among SE patients [18,19,20]. Thus, SE patients with autoimmune encephalitis may generally have better outcomes than predicated by END-IT.…”

Characteristics and outcome‐related factors of seizure at the first onset of autoimmune encephalitis: A retrospective study

“…Patients with anti‐GABABR encephalitis are vulnerable to SE 39 and refractory seizures 18 . For SE, timely immunotherapy is more effective than other therapies such as general anesthesia 40 . Intravenous administration and rapid drug titration may be helpful as necessary 41 .…”

S100A6 Promotes B Lymphocyte Penetration Through the Blood–Brain Barrier in Autoimmune Encephalitis

“…The diagnosis of AE relies on clinical symptoms, autoimmune tests, and, sometimes, the responses to immunotherapy (Zuliani et al, 2012; Graus et al, 2016). Although consensus diagnostic criteria (Graus et al, 2016) have been proposed for AE, the similarities of clinical symptoms between AE and infectious encephalitis frequently make initial clinical differentiation a challenging task (Lin et al, 2019). The autoimmune tests were limited by their availability and the time required for the results.…”