一例电压门控性钾通道抗体相关边缘叶脑炎的病例研究及PET/MRI表现

A case study of voltage-gated potassium channel antibody-related limbic encephalitis with PET/MRI findings.

作者信息

Day Brian K, Eisenman Lawrence, Black Joseph, Maccotta Luigi, Hogan R Edward

机构信息

Department of Neurology, Washington University in St. Louis, Campus Box 8111, 660 South Euclid Avenue, St. Louis, MO 63110, USA.

出版信息

Epilepsy Behav Case Rep. 2015 Jun 6;4:23-6. doi: 10.1016/j.ebcr.2015.02.002. eCollection 2015.

DOI:10.1016/j.ebcr.2015.02.002

PMID:26106579

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4475784/

Abstract

Preclinical and clinical studies have demonstrated the significance of inflammation and autoantibodies in epilepsy, and the use of immunotherapies in certain situations has become an established practice. Temporal lobe epilepsy can follow paraneoplastic or nonparaneoplastic limbic encephalitis associated with antibodies directed against brain antigens. Here, we focus on a patient with worsening confusion and temporal lobe seizures despite treatment with antiepileptic medications. Serial brain MRIs did not conclusively reveal structural abnormalities, so the patient underwent brain PET/MRI to simultaneously evaluate brain structure and function, revealing bitemporal abnormalities. The patient was diagnosed with voltage-gated potassium channel antibody-related limbic encephalitis based on clinical presentation, imaging findings, and antibody testing. Treatment included the addition of a second antiepileptic agent and oral steroids. His seizures and cognitive deficits improved and stabilized.

摘要

临床前和临床研究已证明炎症和自身抗体在癫痫中的重要性，在某些情况下使用免疫疗法已成为既定做法。颞叶癫痫可继发于与针对脑抗原的抗体相关的副肿瘤性或非副肿瘤性边缘性脑炎。在此，我们关注一名尽管接受了抗癫痫药物治疗，但仍出现意识混乱加重和颞叶癫痫发作的患者。系列脑部磁共振成像（MRI）未明确显示结构异常，因此该患者接受了脑部正电子发射断层扫描/磁共振成像（PET/MRI）以同时评估脑结构和功能，结果显示双侧颞叶异常。根据临床表现、影像学检查结果和抗体检测，该患者被诊断为电压门控钾通道抗体相关的边缘性脑炎。治疗包括加用第二种抗癫痫药物和口服类固醇。他的癫痫发作和认知缺陷得到改善并稳定下来。