Document Detail


Autoimmune epilepsy: clinical characteristics and response to immunotherapy.
MedLine Citation:
PMID:  22451162     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of neurology     Volume:  69     ISSN:  1538-3687     ISO Abbreviation:  Arch. Neurol.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-11-01     Completed Date:  2012-11-19     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  0372436     Medline TA:  Arch Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  582-93     Citation Subset:  AIM; IM    
Affiliation:
Department of Laboratory Medicine and Pathology, Mayo Clinic, College of Medicine, Rochester, MN 55905, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
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:
R01 NS053998/NS/NINDS NIH HHS; R01 NS063039/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
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:
Arch Neurol. 2012 May;69(5):565-6   [PMID:  22451161 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  4H Syndrome With Late-Onset Growth Hormone Deficiency Caused by POLR3A Mutations.
Next Document:  PREPARATION AND APPLICATION OF STEEPS OF TEA AS NEW SIMULATIONS OF URINE FOR THE PERFORMANCE TESTING...