Department of Neurology, Northwestern Memorial Hospital, Chicago, Illinois.
Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Semin Neurol. 2020 Dec;40(6):708-718. doi: 10.1055/s-0040-1719111. Epub 2020 Nov 11.
An autoimmune etiology for seizures, epilepsy, and status epilepticus is becoming increasingly recognized. The role of autoimmunity in epilepsy has been highlighted in the literature and the International League Against Epilepsy now recognizes autoimmune epilepsy as a distinct entity. An appropriate and thorough work-up of all new-onset seizures and status epilepticus is paramount in determining the likely efficacy of immunotherapeutic agents in treating seizures and status epilepticus. Criteria for the clinical diagnosis of autoimmune mediated epilepsy and encephalitis have been published by expert consensus and validated models to predict response to immunotherapy exist. These guidelines should guide clinicians about when to promptly start immunotherapy. Immunotherapy has been shown to improve outcomes and may reduce relapse rates in autoimmune encephalitis. Treatment algorithms with immunotherapeutic agents have been established by expert opinion and multiple observational retrospective trials in the past 10 years. However, future prospective randomized controlled trials are still needed to better understand the optimal regimen, dosing schedule, and duration of treatment with immunotherapeutic agents.
自身免疫病因引起的癫痫发作、癫痫和癫痫持续状态越来越受到重视。自身免疫在癫痫中的作用已在文献中得到强调，国际抗癫痫联盟现在将自身免疫性癫痫视为一种独特的实体。对所有新发癫痫发作和癫痫持续状态进行适当和彻底的评估，对于确定免疫治疗药物治疗癫痫发作和癫痫持续状态的可能疗效至关重要。自身免疫性癫痫和脑炎的临床诊断标准已经由专家共识发布，并存在预测免疫治疗反应的验证模型。这些指南应指导临床医生何时及时开始免疫治疗。免疫治疗已被证明可以改善结局，并可能降低自身免疫性脑炎的复发率。过去 10 年，专家意见和多项观察性回顾性试验已经制定了免疫治疗药物的治疗方案。然而，仍需要未来的前瞻性随机对照试验来更好地了解免疫治疗药物的最佳方案、剂量方案和治疗持续时间。
