School of Medicine, Universidad Cesar Vallejo, Trujillo-Perú; Epilepsy Department, Instituto Nacional de Ciencias Neurológicas, Lima-Perú.
Grupo de Investigación Neurociencias, Metabolismo, Efectividad Clínica y Sanitaria (NEMECS), Universidad Científica del Sur, Lima-Perú.
Epilepsy Res. 2024 Oct;206:107439. doi: 10.1016/j.eplepsyres.2024.107439. Epub 2024 Aug 22.
Seizures and epilepsy are well-documented in association with autoimmune encephalitis. Despite this, a notable gap exists in understanding the persistence of seizures beyond the acute phase, particularly within the context of low- and low-middle-income settings.
To evaluate the frequency, clinical characteristics, diagnosis, and potential factors associated with the occurrence and persistence of seizures in autoimmune encephalitis patients.
This was a retrospective, cross-sectional study. Patients diagnosed with possible, probable or confirmed autoimmune encephalitis according to the Graus criteria at the "Instituto Nacional de Ciencias Neurológicas" in Lima, Peru, were included between January 2018 and April 2023. Demographic, clinical, diagnosis, and management information was recorded. A bivariate analysis was performed considering the persistence of seizures at one-year follow-up and a second analysis was performed to compare the groups according to the anti N-methyl-D-aspartate receptor (NMDAR) antibody results.
Sixty patients predominantly male (40; 66.7 %) were included. Only 36 (60 %) patients were tested for antibodies, 16 (44.4 %) were NMDAR positive. 46 (76.7 %) patients had at least one seizure and 13 (37.1 %) had seizures after 1 year of follow-up. Patients with seizure relapse were younger, 20 (IQR: 18-28) versus 29.5 years (IQR: 21-48), p=0.049. Four (44.4 %) patients with persistent seizures had positive NMDAR results. Similar sex distributions, no differences in seizure characteristics, and higher CSF cell count in the NMDAR-positive group were observed. Neuroimaging, EEG findings, and follow-up times were comparable between the groups.
We found a 37.1 % seizures rate after one year of follow-up, predominantly in younger patients.
自身免疫性脑炎与癫痫发作和癫痫有明确的关联。尽管如此，在理解急性阶段后癫痫的持续存在方面，特别是在低收入和中低收入环境中，仍然存在显著的知识差距。
评估自身免疫性脑炎患者中癫痫发作的发生和持续存在的频率、临床特征、诊断和潜在相关因素。
这是一项回顾性、横断面研究。纳入了 2018 年 1 月至 2023 年 4 月期间在秘鲁利马的“Instituto Nacional de Ciencias Neurológicas”根据 Graus 标准诊断为可能、可能或确诊的自身免疫性脑炎患者。记录了人口统计学、临床、诊断和管理信息。进行了双变量分析，考虑了一年随访时癫痫的持续存在，并进行了第二次分析，根据抗 N-甲基-D-天冬氨酸受体 (NMDAR) 抗体结果比较了各组。
共纳入 60 名患者，主要为男性（40 名；66.7%）。仅 36 名（60%）患者进行了抗体检测，16 名（44.4%）为 NMDAR 阳性。46 名（76.7%）患者至少有一次癫痫发作，13 名（37.1%）在随访 1 年后有癫痫发作。癫痫复发的患者年龄更小，20 岁（IQR：18-28）与 29.5 岁（IQR：21-48）相比，p=0.049。4 名（44.4%）持续癫痫发作的患者 NMDAR 结果阳性。观察到 NMDAR 阳性组的性别分布相似、癫痫发作特征无差异，且 CSF 细胞计数更高。神经影像学、脑电图结果和随访时间在两组之间相似。
我们发现随访 1 年后癫痫发作率为 37.1%，主要发生在年轻患者中。
