Huang Wenyao, Zhang Heyu, Li Xi, Zhang Jinming, Chen Jingjing, Chen Ziyi, Ni Guanzhong
Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshan 2 Road, Guangzhou, 510080, Guangdong, China.
J Neurol. 2024 Aug;271(8):5046-5054. doi: 10.1007/s00415-024-12432-y. Epub 2024 May 27.
The aim of our study was to analyze the characteristics of patients with autoimmune encephalitis (AE) to identify prognostic factors associated with the development of drug-resistant epilepsy (DRE).
In this retrospective observational cohort study, we enrolled adult patients with AE between January 2016 and December 2022. The patients were categorized into two groups based on the presence or absence of DRE at the last follow-up. The predictors of the development of DRE were investigated using logistic regression analysis.
Among 121 AE patients, 75.2% (n = 91) experienced acute symptomatic seizures, and 29.8% (n = 36) developed DRE at the last follow-up. On multivariate regression analysis, the factors associated with DRE were antibody negativity (OR 3.628, 95% CI 1.092-12.050, p = 0.035), focal seizure (OR 6.431, 95% CI 1.838-22.508, p = 0.004), refractory status epilepticus (OR 8.802, 95% CI 2.445-31.689, p = 0.001), interictal epileptiform discharges on EEG (OR 6.773, 95% CI 2.206-20.790, p = 0.001), and T2/FLAIR hyperintensity in the limbic system (OR 3.286, 95% CI 1.060-10.183, p = 0.039).
In this study, the risk of developing DRE was mainly observed among AE patients who were negative for antibodies or had focal seizures, refractory status epilepticus, interictal epileptiform discharges on EEG, and T2/FLAIR hyperintensity in the limbic system.
本研究旨在分析自身免疫性脑炎（AE）患者的特征，以确定与耐药性癫痫（DRE）发生相关的预后因素。
在这项回顾性观察性队列研究中，我们纳入了2016年1月至2022年12月期间的成年AE患者。根据最后一次随访时是否存在DRE将患者分为两组。使用逻辑回归分析研究DRE发生的预测因素。
在121例AE患者中，75.2%（n = 91）经历了急性症状性癫痫发作，29.8%（n = 36）在最后一次随访时发生了DRE。多因素回归分析显示，与DRE相关的因素包括抗体阴性（OR 3.628，95%CI 1.092 - 12.050，p = 0.035）、局灶性癫痫发作（OR 6.431，95%CI 1.838 - 22.508，p = 0.004）、难治性癫痫持续状态（OR 8.802，95%CI 2.445 - 31.689，p = 0.001）、脑电图发作间期癫痫样放电（OR 6.773，95%CI 2.206 - 20.790，p = 0.001）以及边缘系统T2/FLAIR高信号（OR 3.286，95%CI 1.060 - 10.183，p = 0.039）。
在本研究中，抗体阴性或有局灶性癫痫发作、难治性癫痫持续状态、脑电图发作间期癫痫样放电以及边缘系统T2/FLAIR高信号的AE患者发生DRE的风险较高。
