抗癫痫药物耐药性局灶性癫痫术前的抗体阳性率（APES）。

Antibody Prevalence in Epilepsy before Surgery (APES) in drug-resistant focal epilepsy.

机构信息

Stanford Comprehensive Epilepsy Center, Stanford University, Palo Alto, CA, USA.

Department of Psychiatry, University of Alberta Hospital, Alberta, Canada.

出版信息

Epilepsia. 2021 Mar;62(3):720-728. doi: 10.1111/epi.16820. Epub 2021 Jan 19.

DOI:10.1111/epi.16820

PMID:33464599

Abstract

OBJECTIVE

There is a growing recognition of immune-mediated causes in patients with focal drug-resistant epilepsy (DRE); however, they are not systematically assessed in the pre-surgical diagnostic workup. Early diagnosis and initiation of immunotherapy is associated with a favorable outcome in immune-mediated seizures. Patients with refractory focal epilepsy with neuronal antibodies (Abs) tend to have a worse surgical prognosis when compared to other etiologies.

METHODS

We studied the prevalence of serum Abs in patients ≥18 years of age with DRE of unknown cause before surgery. We proposed and calculated a clinical APES (Antibody Prevalence in Epilepsy before Surgery) score for each subject, which was modified based on Dubey's previously published APE score. RESULTS`: A total of 335 patients were screened and 86 subjects were included in final analysis. The mean age at the time of recruitment was 44.84 ± 14.86 years, with age at seizure onset 30.89 ± 19.88 years. There were no significant differences among baseline clinical features between retrospective and prospective sub-cohorts. The prevalence of at least one positive Ab was 33.72%, and central nervous system (CNS)-specific Abs was 8.14%. APES score ≥4 showed slightly better overall prediction (area under the curve [AUC]: 0.84 vs 0.74) and higher sensitivity (100% vs 71.4%), with slightly lower but similar specificity (44.3% vs 49.4%), when compared to APE score ≥4. For subjects who had available positron emission tomography (PET) results and all components of APES score (n = 60), the sensitivity of APES score ≥4 yielded a similar prediction potential with an AUC of 0.80.

SIGNIFICANCE

Our findings provide persuasive evidence that a subset of patients with focal DRE have potentially immune-mediated causes. We propose an APES score to help identify patients who may benefit from a workup for immune etiologies during the pre-surgical evaluation for focal refractory epilepsy with unknown cause.

摘要

目的

越来越多的人认识到，在局灶性耐药性癫痫（DRE）患者中存在免疫介导的病因；然而，在术前诊断中并未对其进行系统评估。免疫介导性癫痫发作早期诊断和免疫治疗的启动与良好的预后相关。与其他病因相比，伴有神经元抗体（Abs）的难治性局灶性癫痫患者的手术预后往往较差。

方法

我们研究了术前病因不明的 DRE 患者中血清 Abs 的患病率。我们为每位患者提出并计算了一个临床 APES（手术前癫痫中的抗体患病率）评分，该评分基于 Dubey 先前发表的 APE 评分进行了修改。

结果

共筛选了 335 名患者，最终有 86 名患者纳入最终分析。招募时的平均年龄为 44.84±14.86 岁，发病年龄为 30.89±19.88 岁。回顾性和前瞻性亚组之间的基线临床特征无显著差异。至少有一种阳性 Ab 的患病率为 33.72%，中枢神经系统（CNS）特异性 Abs 的患病率为 8.14%。APES 评分≥4 时，总体预测效果略好（曲线下面积[AUC]：0.84 对 0.74），敏感性更高（100%对 71.4%），特异性略低但相似（44.3%对 49.4%），与 APE 评分≥4 相比。对于有可用正电子发射断层扫描（PET）结果和 APES 评分所有成分的患者（n=60），APES 评分≥4 的敏感性具有相似的预测潜力，AUC 为 0.80。