Abstract
PurposeTo investigate the clinical characteristics of acute symptomatic seizures and the predictors of the development of epilepsy in patients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis.MethodsWe retrospectively screened the medical records of 86 hospitalized patients with confirmed autoimmune encephalitis (AE). The clinical characteristics of acute symptomatic seizures were analyzed. The predictors of the development of epilepsy were investigated using logistic regression analysis.ResultsA total of 86 patients with AE were finally included. Eighty-six percent of patients (n = 74) experienced acute symptomatic seizures, and 28.4% of patients developed epilepsy during follow-up. Abnormal EEG findings were more frequent in AE patients with acute symptomatic seizures. A greater number of anti-seizure medications (ASMs), abnormal EEG findings, and delayed immunotherapy were found to be independently associated with the development of epilepsy.ConclusionAcute symptomatic seizures are a common manifestation in AE patients. During follow-up, 28.4% of AE patients developed epilepsy. The independent factors that predicted the development of epilepsy after the acute phase included a larger number of ASMs, EEG abnormalities, and delayed immunotherapy. In clinical practice, we should prioritize immunotherapy to control acute seizures as soon as possible. For AE patients with an increased risk of developing epilepsy, early withdrawal of ASM is not recommended.
Highlights
It has been increasingly acknowledged in recent years that autoimmune encephalitis (AE) refers to a number of inflammatory autoimmune disorders of the brain that are associated with autoantibodies against neurosurface, synaptic or neuronal intracytoplasmic antigens [1,2,3]
We aimed to answer the following questions in this study: How many AE patients experience acute symptomatic seizures in the acute phase? Which demographic or clinical characteristics are associated with acute symptomatic seizures? How many patients develop epilepsy after the acute phase of AE? What are the predictors of the development of epilepsy in AE patients?
37 patients were positive for anti-NMDAR (43%), 34 patients (40%) for anti-LGI1, and 15 patients for anti-GABABR (17%) encephalitis
Summary
It has been increasingly acknowledged in recent years that autoimmune encephalitis (AE) refers to a number of inflammatory autoimmune disorders of the brain that are associated with autoantibodies against neurosurface, synaptic or neuronal intracytoplasmic antigens [1,2,3]. Acute symptomatic seizures are common clinical manifestations in the acute phase of AE, and more than half of AE patients experience seizure onset [4, 5]. The effect of anti-seizure medications (ASMs) on acute seizure control is limited, and the responses to ASMs are poor in AE patients [6]. Withdrawal of ASM is not associated with the development of epilepsy after the acute phase [7]. Prior evidence has shown good acute seizure control outcomes in most AE patients [8, 9]. Freedom from seizures is achieved soon after the initiation of immunotherapy in most AE patients with seizures [6]
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