Department of Neurology, CHA University, Bundang CHA Medical Center, Republic of Korea.
Department of Neurology, Korea University Anam Hospital, Korea University Medicine Center, Republic of Korea; Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
J Neuroimmunol. 2018 Feb 15;315:1-8. doi: 10.1016/j.jneuroim.2017.12.004. Epub 2017 Dec 12.
Autoimmune and unknown/cryptogenic encephalitis have been increasingly noted in the inflammatory etiology of new-onset status epilepticus (SE). We aimed to investigate clinical characteristics and the potential role of immunotherapy in encephalitis-related adult SE through our multicenter prospective SE registry. Among the 274 patients with SE, 35 (12.8%) patients demonstrated an inflammatory etiology and 19 out of 35 (54.3%) patients demonstrated unknown/cryptogenic cause. Patients with autoimmune and unknown/cryptogenic encephalitis shared similar clinical features. In unknown/cryptogenic encephalitis, the proportion of favorable outcomes (mRS 0-3) showed a different propensity at 3-6months after discharge between patients receiving active immunotherapy and not receiving any immunotherapy, although it was not statistically significant (at admission 28.6% vs 20%, p=0.603; at discharge 57.1% vs 60%, p=0.570; at 3-6months after discharge 90% vs 60%, p=0.214 in patients treated with active immunotherapy or without immunotherapy, respectively). Extensive autoantibody screening should be carried out and empirical immunotherapy may be potentially helpful even in patients without antibodies, although longer term and multi-national studies may be necessary to make a stronger recommendation.
自身免疫性和未知/隐源性脑炎在新发癫痫持续状态（SE）的炎症病因中越来越受到关注。我们旨在通过多中心前瞻性 SE 登记处研究脑炎相关成人 SE 的临床特征和免疫治疗的潜在作用。在 274 例 SE 患者中，35 例（12.8%）患者表现为炎症病因，35 例患者中有 19 例（54.3%）为未知/隐源性病因。自身免疫性和未知/隐源性脑炎患者具有相似的临床特征。在未知/隐源性脑炎中，接受主动免疫治疗和未接受任何免疫治疗的患者在出院后 3-6 个月的预后良好（mRS 0-3）的比例存在不同倾向，但差异无统计学意义（入院时分别为 28.6%和 20%，p=0.603；出院时分别为 57.1%和 60%，p=0.570；出院后 3-6 个月时分别为 90%和 60%，p=0.214）。尽管可能需要进行更长时间和多国家的研究来提出更有力的建议，但应进行广泛的自身抗体筛查，并且即使在没有抗体的患者中，经验性免疫治疗也可能是有益的。
