Comprehensive Epilepsy Center, Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Neurology and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Neurotherapeutics. 2019 Jul;16(3):685-702. doi: 10.1007/s13311-019-00750-3.
The field of autoimmune epilepsy has evolved substantially in the last few decades with discovery of several neural autoantibodies and improved mechanistic understanding of these immune-mediated syndromes. A considerable proportion of patients with epilepsy of unknown etiology have been demonstrated to have an autoimmune cause. The majority of the patients with autoimmune epilepsy usually present with new-onset refractory seizures along with subacute progressive cognitive decline and behavioral or psychiatric dysfunction. Neural specific antibodies commonly associated with autoimmune epilepsy include leucine-rich glioma-inactivated protein 1 (LGI1), N-methyl-D-aspartate receptor (NMDA-R), and glutamic acid decarboxylase 65 (GAD65) IgG. Diagnosis of these cases depends on the identification of the clinical syndrome and ancillary studies including autoantibody evaluation. Predictive models (Antibody Prevalence in Epilepsy and Encephalopathy [APE2] and Response to Immunotherapy in Epilepsy and Encephalopathy [RITE2] scores) based on clinical features and initial neurological assessment may be utilized for selection of cases for autoimmune epilepsy evaluation and management. In this article, we will review the recent advances in autoimmune epilepsy and provide diagnostic and therapeutic algorithms for epilepsies with suspected autoimmune etiology.
自身免疫性癫痫领域在过去几十年中取得了重大进展,发现了几种神经自身抗体,并对这些免疫介导的综合征有了更好的机制理解。大量病因不明的癫痫患者被证实存在自身免疫原因。大多数自身免疫性癫痫患者通常表现为新发难治性癫痫发作,伴有亚急性进行性认知功能下降以及行为或精神功能障碍。常见的与自身免疫性癫痫相关的神经特异性抗体包括富含亮氨酸胶质瘤失活蛋白 1(LGI1)、N-甲基-D-天冬氨酸受体(NMDA-R)和谷氨酸脱羧酶 65(GAD65)IgG。这些病例的诊断取决于临床综合征的识别和辅助研究,包括自身抗体评估。基于临床特征和初始神经评估的预测模型(癫痫和脑病中的抗体流行率[APE2]和癫痫和脑病中的免疫治疗反应[RITE2]评分)可用于选择自身免疫性癫痫评估和管理的病例。本文将综述自身免疫性癫痫的最新进展,并为疑似自身免疫性病因的癫痫提供诊断和治疗算法。