Du Jinyuan, Guo Yi, Zhu Qiong
Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.
Front Neurol. 2023 Mar 23;14:1111384. doi: 10.3389/fneur.2023.1111384. eCollection 2023.
Seizures are the main manifestation of the acute phase of autoimmune encephalitis (AE). Anti-seizure medications (ASMs) play an important role in controlling seizures in AE patients, but there is currently a lack of consensus regarding the selection, application, and discontinuation of ASMs. This narrative review focuses on the use of ASMs in patients with AE driven by different antibodies. The PubMed, Embase, and MEDLINE databases were searched up until 30 October 2022 using prespecified search terms. We identified 2,580 studies; 23 retrospective studies, 2 prospective studies and 9 case reports were evaluated based on our inclusion criteria. Anti-N-methyl-D-aspartic-acid-receptor (anti-NMDAR) encephalitis is the type of AE that responds best to ASMs, and long-term or combined use of ASMs may be not required in most patients with seizures; these results apply to both adults and children. Sodium channel blockers may be the best option for seizures in anti-leucine-rich-glioma-inactivated-1 (anti-LGI1) encephalitis, but patients with anti-LGI1 encephalitis are prone to side effects when using ASMs. Cell surface antibody-mediated AE patients are more likely to use ASMs for a long period than patients with intracellular antibody-mediated AE. Clinicians can score AE patients' clinical characteristics on a scale to identify those who may require long-or short-term use of ASMs in the early stage. This review provides some recommendations for the rational use of ASMs in encephalitis mediated by different antibodies with the aim of controlling seizures and avoiding overtreatment.
癫痫发作是自身免疫性脑炎（AE）急性期的主要表现。抗癫痫药物（ASMs）在控制AE患者的癫痫发作方面发挥着重要作用，但目前在ASMs的选择、应用和停用方面缺乏共识。本叙述性综述聚焦于不同抗体驱动的AE患者中ASMs的使用情况。截至2022年10月30日，使用预先设定的检索词对PubMed、Embase和MEDLINE数据库进行了检索。我们共识别出2580项研究；根据纳入标准，对23项回顾性研究、2项前瞻性研究和9篇病例报告进行了评估。抗N-甲基-D-天冬氨酸受体（anti-NMDAR）脑炎是对ASMs反应最佳的AE类型，大多数癫痫发作患者可能无需长期或联合使用ASMs；这些结果适用于成人和儿童。钠通道阻滞剂可能是抗富含亮氨酸胶质瘤失活1（anti-LGI1）脑炎癫痫发作的最佳选择，但anti-LGI1脑炎患者使用ASMs时易出现副作用。细胞表面抗体介导的AE患者比细胞内抗体介导的AE患者更有可能长期使用ASMs。临床医生可以对AE患者的临床特征进行评分，以识别那些在早期可能需要长期或短期使用ASMs的患者。本综述为合理使用ASMs治疗不同抗体介导的脑炎提供了一些建议，旨在控制癫痫发作并避免过度治疗。
