Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy.
BIOMORF Department, Neurology Unit, University of Messina, Messina, Italy.
Curr Neuropharmacol. 2023;21(8):1714-1735. doi: 10.2174/1570159X20666220706094651.
Several studies have focused on the emerging role of immunity and inflammation in a wide range of neurological disorders. Autoimmune diseases involving central nervous system share well defined clinical features including epileptic seizures and additional neuropsychiatric symptoms, like cognitive and psychiatric disturbances. The growing evidence about the role of immunity in the pathophysiologic mechanisms underlying these conditions lead to the concept of autoimmune epilepsy. This relatively-new term has been introduced to highlight the etiological and prognostic implications of immunity in epileptogenesis. In this review, we aim to discuss the role of autoimmunity in epileptogenesis and its clinical, neurophysiological, neuroimaging and therapeutic implications. Moreover, we wish to address the close relationship between immunity and additional symptoms, particularly cognitive and psychiatric features, which deeply impact clinical outcomes in these patients. To assess these aspects, we first analyzed Rasmussen's encephalitis. Subsequently, we have covered autoimmune encephalitis, particularly those associated with autoantibodies against surface neuronal antigens, as these autoantibodies express a direct immune-mediated mechanism, different from those against intracellular antigens. Then, we discussed the connection between systemic immune disorders and neurological manifestations. This review aims to highlight the need to expand knowledge about the role of inflammation and autoimmunity in the pathophysiology of neurological disorders and the importance to early recognize these clinical entities. Indeed, early identification may result in faster recovery and a better prognosis.
已有多项研究聚焦于免疫和炎症在广泛的神经紊乱中的新作用。涉及中枢神经系统的自身免疫性疾病具有明确的临床特征，包括癫痫发作和其他神经精神症状，如认知和精神障碍。越来越多的证据表明免疫在这些疾病的病理生理机制中的作用，导致了自身免疫性癫痫的概念。这个相对较新的术语被引入，以强调免疫在癫痫发生中的病因和预后意义。在这篇综述中，我们旨在讨论自身免疫在癫痫发生中的作用及其临床、神经生理学、神经影像学和治疗意义。此外，我们希望探讨免疫与其他症状（特别是认知和精神症状）之间的密切关系，这些症状对这些患者的临床结局有深远影响。为了评估这些方面，我们首先分析了拉森氏脑炎。随后，我们涵盖了自身免疫性脑炎，特别是那些与针对表面神经元抗原的自身抗体相关的脑炎，因为这些自身抗体表达了一种直接的免疫介导机制，与针对细胞内抗原的机制不同。然后，我们讨论了系统性免疫紊乱与神经表现之间的联系。这篇综述旨在强调需要扩展对炎症和自身免疫在神经紊乱病理生理学中的作用的认识，以及早期识别这些临床实体的重要性。事实上，早期识别可能导致更快的恢复和更好的预后。
