Feyissa Anteneh M, López Chiriboga A Sebastian, Britton Jeffrey W
Department of Neurology (A.M.F., A.S.L.C.), Mayo Clinic, Jacksonville, FL; and Department of Neurology (J.W.B.), Mayo Clinic, Rochester, MN.
Neurol Neuroimmunol Neuroinflamm. 2017 May 10;4(4):e353. doi: 10.1212/NXI.0000000000000353. eCollection 2017 Jul.
We aimed to report the pattern of usage and efficacy of antiepileptic drugs (AEDs) in patients with autoimmune epilepsy (AE).
We retrospectively studied the Mayo Clinic's electronic medical record of patients with AE in which seizures were the main presenting feature. Clinical data, including demographics, seizure characteristics, type of AED and immunotherapy used, presence of neural antibody, and treatment outcomes, were reviewed.
The medical records of 252 adult patients diagnosed with autoimmune encephalitis and paraneoplastic disorders were reviewed. Seizure was the initial presentation in 50 patients (20%). Serum and/or CSF autoantibodies were detected in 41 (82%) patients, and 38 (76%) patients had neural autoantibodies. The majority (n = 43, 86%) received at least 1 form of immunotherapy in combination with AEDs, while the remainder received AEDs alone. Twenty-seven patients (54%) became seizure free: 18 (36%) with immunotherapy, 5 (10%) with AEDs alone, and 4 (8%) with AEDs after immunotherapy failure. Levetiracetam was the most commonly used (42/50); however, it was associated with 0% seizure-free response. AED seizure-free responses occurred with carbamazepine (n = 3) [3/16, 18.8%], lacosamide (n = 3) [3/18, 16.6%] with phenytoin (n = 1) [1/8, 12.5%], or oxcarbazepine (n = 2) [2/11, 18.1%]. Regardless of the type of therapy, voltage-gated potassium channel-complex antibody-positive patients were more likely to become seizure free compared with glutamic acid decarboxylase 65 antibody-positive cases (12/17 vs 2/10, = 0.0183).
In select patients, AEDs alone were effective in controlling seizures. AEDs with sodium channel blocking properties resulted in seizure freedom in a few cases. Prospective studies are needed to clarify AED selection and to elucidate their immunomodulatory properties in AE.
我们旨在报告自身免疫性癫痫（AE）患者抗癫痫药物（AEDs）的使用模式及疗效。
我们回顾性研究了梅奥诊所以癫痫发作为主要表现特征的AE患者的电子病历。对临床数据进行了审查，包括人口统计学资料、癫痫发作特征、所使用的AED类型和免疫治疗、神经抗体的存在情况以及治疗结果。
对252例诊断为自身免疫性脑炎和副肿瘤性疾病的成年患者的病历进行了审查。癫痫发作是50例患者（20%）的初始表现。41例（82%）患者检测到血清和/或脑脊液自身抗体，38例（76%）患者有神经自身抗体。大多数患者（n = 43，86%）接受了至少1种形式的免疫治疗联合AEDs，其余患者仅接受AEDs治疗。27例患者（54%）癫痫发作停止：18例（36%）接受免疫治疗，5例（10%）仅接受AEDs治疗，4例（8%）在免疫治疗失败后接受AEDs治疗。左乙拉西坦是最常用的药物（42/50）；然而，其癫痫发作停止反应率为0%。卡马西平（n = 3）[3/16，18.8%]、拉科酰胺（n = 3）[三/十八，16.6%]、苯妥英（n = 1）[1/8，12.5%]或奥卡西平（n = 2）[2/11，18.1%]出现了AEDs癫痫发作停止反应。无论治疗类型如何，与谷氨酸脱羧酶抗体65阳性病例相比，电压门控钾通道复合物抗体阳性患者更有可能癫痫发作停止（12/17对2/10，P = 0.0183）。
在部分患者中，单独使用AEDs可有效控制癫痫发作。具有钠通道阻滞特性的AEDs在少数情况下可使癫痫发作停止。需要进行前瞻性研究以明确AEDs的选择，并阐明其在AE中的免疫调节特性。
