Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore 560029, India.
Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
Seizure. 2024 Oct;121:162-171. doi: 10.1016/j.seizure.2024.08.010. Epub 2024 Aug 13.
An abnormal EEG is pivotal in diagnosis, exclusion of mimickers and prognosticating epilepsy in Autoimmune Encephalitis (AE). However, little is known about the short and long term electroencephalographic outcomes and predictors of epilepsy in AE. This study aims to describe the seizure characteristics and electrophysiological markers of various AE subtypes and assess the clinical and electrophysiological predictors of autoimmune epilepsy.
Clinical features and EEGs in 74 patients (acute phase=39 and post-acute phase defined after a minimum eight weeks after acute phase=35) of AE fulfilling the proposed criteria were reviewed in their respective acute phases and at six months follow-up.
The mean age of presentation (N = 74, 45 females) was 21.8 (21.8 ± 17.0) years. 38 (51 %) patients were <18 years. Seizures were present in 55 (74 %) patients with poor response to ASMs (p = 0.039). 39 (52.7 %) EEGs were abnormal in acute phase. Anti-NMDAR AE had most frequently abnormal EEG (63.4 %). Poor background reactivity and theta range slowing were most common abnormalities. FIRDA, EDB and delta range slowing were seen in seropositive AE (P = 0.003). Mutism, psychiatric features and incontinence correlated with abnormal EEG (p = 0.013, p = 0.028 and p = 0.025). Background slowing and epileptiform discharges predicted worse cognitive scores at follow-up (p = 0.012). Eight (11.9 %) patients developed epilepsy. Status epilepticus at presentation (p = 0.009), seronegative status (p = 0.0020), delayed initiation of immunotherapy (p = 0.012), abnormal MRI (p = 0.003) and abnormal EEG (p = 0.004) at onset indicate development of autoimmune epilepsy CONCLUSIONS: FIRDA, EDB and delta range slowing with refractory seizures suggest AE. Epileptiform abnormalities, status epilepticus and seronegativity predict autoimmune epilepsy.
异常脑电图在自身免疫性脑炎（AE）的诊断、排除类似疾病和预测癫痫方面至关重要。然而，对于 AE 中各种亚型的脑电图结果和癫痫预测因素，人们知之甚少。本研究旨在描述各种 AE 亚型的癫痫发作特征和电生理标志物，并评估自身免疫性癫痫的临床和电生理预测因素。
对符合建议标准的 74 例 AE 患者（急性期=39 例，急性后期定义为急性期后至少 8 周=35 例）的临床特征和脑电图进行回顾性分析，分析时间分别为急性期和 6 个月随访期。
纳入的 74 例患者（45 例女性）的平均年龄为 21.8（21.8±17.0）岁，38 例（51%）患者年龄小于 18 岁。55 例（74%）患者出现癫痫发作，对 ASM 反应不佳（p=0.039）。39 例（52.7%）患者的脑电图在急性期异常。抗-NMDAR AE 最常出现异常脑电图（63.4%）。最常见的异常是背景反应不良和θ频段减慢。在血清阳性 AE 中可见 FIRDA、EDB 和δ频段减慢（P=0.003）。缄默症、精神症状和尿失禁与异常脑电图相关（p=0.013、p=0.028 和 p=0.025）。背景减慢和癫痫样放电预测随访时认知评分更差（p=0.012）。8 例（11.9%）患者发展为癫痫。起病时出现癫痫持续状态（p=0.009）、血清阴性（p=0.0020）、免疫治疗延迟开始（p=0.012）、起病时 MRI 异常（p=0.003）和脑电图异常（p=0.004）提示发展为自身免疫性癫痫。
伴有难治性癫痫的 FIRDA、EDB 和 δ频段减慢提示 AE。癫痫样异常、癫痫持续状态和血清阴性预测自身免疫性癫痫。
