Huang Qi, Ma Meigang, Wei Xing, Liao Yuhan, Qi Hengchang, Wu Yuejuan, Wu Yuan
Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, China.
Front Neurol. 2019 Jan 8;9:1136. doi: 10.3389/fneur.2018.01136. eCollection 2018.
Autoimmune encephalitis (AE) is one kind of encephalitis that associates with specific neuronal antigens. Most patients with AE likely suffer from seizures, but data on the characteristics of seizure and antiepileptic drugs (AEDs) utilization in this patient group remains limited. This study aimed to report the clinical status of seizure and AEDs treatment of patients with AE, and to evaluate the relationship between AEDs discontinuation and seizure outcomes. Patients with acute neurological disorders and anti-N-methyl-D-aspartate receptor (NMDAR), γ-aminobutyric acid B receptor (GABAR), leucine-rich glioma inactivated 1, or contactin-associated protein-like 2 (CASPR2) antibodies were included. As patients withdrew from AEDs, they were divided into the early withdrawal (EW, AEDs used ≤3 months) and late withdrawal (LW, AEDs used >3 months) groups. Seizure remission was defined as having no seizures for at least 1 year after the last time when AEDs were administered. Seizure outcomes were assessed on the basis of remission rate. The factors affecting the outcomes were assessed through Spearman analysis. In total, we enrolled 75 patients (39 patients aged <16 years, male/female = 39/36) for follow-up, which included 67 patients with anti-NMDAR encephalitis, 4 patients with anti-GABAR encephalitis, 2 patients with anti-voltage-gated potassium channel encephalitis, and 2 patients with coexisting antibodies. Among the 34 enrolled patients with anti-NMDAR encephalitis who were withdrawn from AEDs, only 5.8% relapse was reported during the 1-year follow-up, with no significant difference in the percentage of relapse between the EW and LW groups ( = 0.313). Fifteen patients (an average age of 6.8, 14 patients with anti-NMDAR encephalitis and 1 patient with anti-CASPR2 encephalitis) presented seizure remission without any AEDs. Seventy five percent of patients with anti-GABAR antibodies developed refractory seizure. Other risk factors which contributed to refractory seizure and seizure relapse included status epilepticus ( = 0.004) and cortical abnormalities ( = 0.028). Given this retrospective data, patients with AE have a high rate of seizure remission, and the long-term use of AEDs may not be necessary to control the seizure. Moreover, seizures in young patients with anti-NMDAR encephalitis presents self-limited. Patients with anti-GABAR antibody, status epilepticus, and cortical abnormalities are more likely to develop refractory seizure or seizure relapse.
自身免疫性脑炎（AE）是一种与特定神经元抗原相关的脑炎。大多数AE患者可能会发生癫痫，但关于该患者群体癫痫发作特征及抗癫痫药物（AEDs）使用情况的数据仍然有限。本研究旨在报告AE患者的癫痫发作情况及AEDs治疗现状，并评估停用AEDs与癫痫发作结局之间的关系。纳入患有急性神经系统疾病且存在抗N-甲基-D-天冬氨酸受体（NMDAR）、γ-氨基丁酸B受体（GABAR）、富含亮氨酸的胶质瘤失活蛋白1或接触蛋白相关蛋白样2（CASPR2）抗体的患者。当患者停用AEDs时，将其分为早期停药组（EW，使用AEDs≤3个月）和晚期停药组（LW，使用AEDs>3个月）。癫痫发作缓解定义为在最后一次使用AEDs后至少1年无癫痫发作。根据缓解率评估癫痫发作结局。通过Spearman分析评估影响结局的因素。我们共纳入75例患者（39例年龄<16岁，男/女=39/36）进行随访，其中包括67例抗NMDAR脑炎患者、4例抗GABAR脑炎患者、2例抗电压门控钾通道脑炎患者和2例存在共存抗体的患者。在34例停用AEDs的抗NMDAR脑炎患者中，1年随访期间仅报告了5.8%的复发率，EW组和LW组之间的复发率无显著差异（P=0.313）。15例患者（平均年龄6.8岁，14例抗NMDAR脑炎患者和1例抗CASPR2脑炎患者）未使用任何AEDs即出现癫痫发作缓解。75%的抗GABAR抗体患者发生难治性癫痫发作。导致难治性癫痫发作和癫痫复发的其他危险因素包括癫痫持续状态（P=0.004）和皮质异常（P=0.028）。基于这些回顾性数据，AE患者癫痫发作缓解率较高，可能无需长期使用AEDs来控制癫痫发作。此外，抗NMDAR脑炎的年轻患者癫痫发作具有自限性。抗GABAR抗体、癫痫持续状态和皮质异常的患者更易发生难治性癫痫发作或癫痫复发。
