Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.
Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy; Neurology Unit, "San Camillo de' Lellis" General Hospital, Rieti, Italy.
Seizure. 2020 Dec;83:160-168. doi: 10.1016/j.seizure.2020.10.019. Epub 2020 Oct 31.
Seizures are common in autoimmune encephalitis (AE), and an extensive work-up is required to exclude alternative etiologies. The aim of our study was to identify possible clinical/EEG peculiarities suggesting the immune-mediated origin of late-onset seizures.
Thirty patients diagnosed with AE (19 men, median age 68 years, 18 seronegative) were included. Overall 212 video-electroencephalographic (EEG) and 31 24-h ambulatory EEG (AEEG) recordings were retrospectively reviewed. Posterior dominant rhythm, interictal epileptiform discharges (IEDs), clinical (CSs) and subclinical seizures (SCSs) were analyzed.
Six-hundred-nineteen ictal events were recorded in 19/30 subjects, mostly (568/619) during AE acute stage. Among ten patients with CSs other than faciobrachial dystonic seizures, 7 showed prominent autonomic and emotional manifestations. SCSs were detected in 11 subjects, mainly via AEEG (260/287 SCSs vs 150/332 CSs, p < 0.001). Eight patients presented seizures during hyperventilation. IEDs, documented in 21 cases, were bilateral in 14 and focal temporal in 13. Multiple ictal EEG patterns were detected in 9/19 patients, 6 of whom had both CSs and SCSs, bilateral asynchronous seizures and ictal activities arising from temporal and extra-temporal regions. No correlation was found between the lateralization of MRI alterations and that of EEG findings.
Our study confirms that adult-onset, high frequency focal seizures with prominent autonomic and emotional manifestations should be investigated for AE. Multiple ictal EEG patterns could represent a 'red flag', reflecting a widespread neuronal excitability related to the underlying immune-mediated process. Finally, our work enhances the crucial role of long-lasting EEG monitoring in revealing subclinical and relapsing seizures.
自身免疫性脑炎（AE）常伴有癫痫发作，需要进行广泛的检查以排除其他病因。本研究旨在确定可能的临床/脑电图特征，提示迟发性癫痫发作的免疫介导起源。
纳入 30 例确诊为 AE 的患者（男 19 例，中位年龄 68 岁，18 例血清阴性）。回顾性分析了 212 例视频-脑电图（EEG）和 31 例 24 小时动态脑电图（AEEG）记录。分析了后部优势节律、发作间期癫痫样放电（IEDs）、临床发作（CSs）和亚临床发作（SCSs）。
19/30 例患者共记录到 619 次癫痫发作，其中 568/619 次发生在 AE 急性发作期。10 例非面肩肱型肌张力障碍性 CSs 患者中，7 例表现出明显的自主神经和情绪表现。11 例患者通过 AEEG 检测到 SCSs（260/287 次 SCSs 与 150/332 次 CSs，p <0.001）。8 例患者在过度通气时出现癫痫发作。21 例患者记录到 IEDs，其中 14 例为双侧，13 例为局灶性颞叶。19 例患者中有 9 例存在多种癫痫样脑电图模式，其中 6 例既有 CSs 又有 SCSs、双侧异步发作和起源于颞叶和颞外区域的发作活动。MRI 改变的侧化与 EEG 结果的侧化之间无相关性。
本研究证实，成人起病、高频局灶性癫痫发作伴明显自主神经和情绪表现应考虑 AE。多种癫痫样脑电图模式可能是一个“红旗”，反映了与潜在免疫介导过程相关的广泛神经元兴奋性。最后，我们的工作强调了长时间脑电图监测在揭示亚临床和复发发作中的重要作用。
