| Autoimmune epilepsy: clinical characteristics and response to immunotherapy. | |
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MedLine Citation:
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PMID: 22451162 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To describe clinical characteristics and immunotherapy responses in patients with autoimmune epilepsy. DESIGN: Observational, retrospective case series. SETTING: Mayo Clinic Health System. PATIENTS: Thirty-two patients with an exclusive (n=11) or predominant (n=21) seizure presentation in whom an autoimmune etiology was suspected (on the basis of neural autoantibody [91%], inflammatory cerebrospinal fluid [31%], or magnetic resonance imaging suggesting inflammation [63%]) were studied. All had partial seizures: 81% had failed treatment with 2 or more antiepileptic drugs and had daily seizures and 38% had seizure semiologies that were multifocal or changed with time. Head magnetic resonance imaging was normal in 15 (47%) at onset. Electroencephalogram abnormalities included interictal epileptiform discharges in 20; electrographic seizures in 15; and focal slowing in 13. Neural autoantibodies included voltage-gated potassium channel complex in 56% (leucine-rich, glioma-inactivated 1 specific, 14; contactin-associated proteinlike 2 specific, 1); glutamic acid decarboxylase 65 in 22%; collapsin response- mediator protein 5 in 6%; and Ma2, N-methyl-D-aspartate receptor, and ganglionic acetylcholine receptor in 1 patient each. INTERVENTION: Immunotherapy with intravenous methylprednisolone; intravenous immune globulin; and combinations of intravenous methylprednisolone, intravenous immune globulin, plasmapheresis, or cyclophosphamide. MAIN OUTCOME MEASURE: Seizure frequency. RESULTS: After a median interval of 17 months (range, 3-72 months), 22 of 27 (81%) reported improvement postimmunotherapy; 18 were seizure free. The median time from seizure onset to initiating immunotherapy was 4 months for responders and 22 months for nonresponders (P<.05). All voltage-gated potassium channel complex antibody-positive patients reported initial or lasting benefit (P<.05). One voltage-gated potassium channel complex antibody-positive patient was seizure free after thyroid cancer resection; another responded to antiepileptic drug change alone. CONCLUSION: When clinical and serological clues suggest an autoimmune basis for medically intractable epilepsy, early-initiated immunotherapy may improve seizure outcome. |
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Authors:
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Amy M L Quek; Jeffrey W Britton; Andrew McKeon; Elson So; Vanda A Lennon; Cheolsu Shin; Christopher Klein; Robert E Watson; Amy L Kotsenas; Terrence D Lagerlund; Gregory D Cascino; Gregory A Worrell; Elaine C Wirrell; Katherine C Nickels; Allen J Aksamit; Katherine H Noe; Sean J Pittock |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Archives of neurology Volume: 69 ISSN: 1538-3687 ISO Abbreviation: Arch. Neurol. Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-11-01 Completed Date: 2012-11-19 Revised Date: 2013-04-18 |
Medline Journal Info:
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Nlm Unique ID: 0372436 Medline TA: Arch Neurol Country: United States |
Other Details:
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Languages: eng Pagination: 582-93 Citation Subset: AIM; IM |
Affiliation:
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Department of Laboratory Medicine and Pathology, Mayo Clinic, College of Medicine, Rochester, MN 55905, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Autoantibodies / cerebrospinal fluid Brain / pathology, radionuclide imaging Cyclophosphamide / therapeutic use Electroencephalography Epilepsy* / etiology, immunology, therapy Female Fluorodeoxyglucose F18 / diagnostic use Humans Immunoglobulins / therapeutic use Immunologic Factors / therapeutic use Immunotherapy / methods* Inflammation / cerebrospinal fluid, complications* Magnetic Resonance Imaging Male Methylprednisolone / therapeutic use Middle Aged Nerve Tissue Proteins / immunology Plasmapheresis / methods Positron-Emission Tomography Retrospective Studies Treatment Outcome Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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R01 NS053998/NS/NINDS NIH HHS; R01 NS063039/NS/NINDS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Autoantibodies; 0/Immunoglobulins; 0/Immunologic Factors; 0/Nerve Tissue Proteins; 50-18-0/Cyclophosphamide; 63503-12-8/Fluorodeoxyglucose F18; 83-43-2/Methylprednisolone |
| Comments/Corrections | |
Comment In:
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Arch Neurol. 2012 May;69(5):565-6
[PMID:
22451161
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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