Lai Qingwei, Chen Yue, Wang Wei, Lian Zhangxu, Liu Tengfei, Wen Chunmei
Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.
Department of Neurology, Yancheng First People's Hospital, Yancheng, People's Republic of China.
J Inflamm Res. 2024 Dec 24;17:11529-11543. doi: 10.2147/JIR.S481729. eCollection 2024.
The aims of this study were to investigate clinical factors associated with encephalitis relapse and chronic epilepsy development, and to evaluate the effectiveness of immunotherapy on encephalitis relapse.
Patients with autoimmune encephalitis diagnosed as positive for neuronal surface antibodies in five general hospitals were included. A minimum 12-month follow-up period was conducted, and binary logistic regression analysis was used to identify predictors of encephalitis relapse and chronic epilepsy development. Additionally, decision curve analysis (DCA) was employed to assess the clinical net benefit of predicting encephalitis relapse and chronic epilepsy.
The study encompassed 65 patients with autoimmune encephalitis. The one-year relapse rate for encephalitis was 13.9%. The CASE score (=0.045) was associated with encephalitis relapse, with subsequent immunotherapy proving beneficial in enhancing outcomes. Chronic epilepsy prevalence at one year was 26.2%, particularly higher among patients with positive LGI1 antibodies. Although adjustments in antiseizure medications were partially effective, 41.2% of patients developed drug-resistant epilepsy (DRE). DCA confirmed that the predictive models provided significant net clinical benefit in assessing the risk of encephalitis relapse and chronic epilepsy. Notably, the presence of diffuse cortical atrophy, medial temporal lobe atrophy, or cerebellar hemisphere atrophy was linked to relapsing encephalitis and chronic epilepsy.
Most cases of autoimmune encephalitis are effectively managed, however, a minority of patients experience relapse or chronic epilepsy. The CASE score and LGI1 antibodies are independent risk factors for encephalitis relapse and chronic epilepsy development, respectively. Immunotherapy remains beneficial for relapsing patients, yet a portion may progress to DRE. Individuals with relapses and chronic epilepsy are predisposed to the development of cortical, temporal lobe, and cerebellar atrophy.
本研究旨在调查与脑炎复发和慢性癫痫发展相关的临床因素，并评估免疫疗法对脑炎复发的有效性。
纳入在五家综合医院被诊断为神经元表面抗体阳性的自身免疫性脑炎患者。进行了至少12个月的随访期，并使用二元逻辑回归分析来确定脑炎复发和慢性癫痫发展的预测因素。此外，采用决策曲线分析（DCA）来评估预测脑炎复发和慢性癫痫的临床净效益。
该研究纳入了65例自身免疫性脑炎患者。脑炎的一年复发率为13.9%。CASE评分（=0.045）与脑炎复发相关，随后的免疫疗法被证明有助于改善预后。一年时慢性癫痫的患病率为26.2%，在LGI1抗体阳性的患者中尤其更高。尽管调整抗癫痫药物有部分效果，但41.2%的患者发展为药物难治性癫痫（DRE）。DCA证实，预测模型在评估脑炎复发和慢性癫痫风险方面提供了显著的临床净效益。值得注意的是，弥漫性皮质萎缩、内侧颞叶萎缩或小脑半球萎缩的存在与复发性脑炎和慢性癫痫有关。
大多数自身免疫性脑炎病例得到有效管理，然而，少数患者会复发或发展为慢性癫痫。CASE评分和LGI1抗体分别是脑炎复发和慢性癫痫发展的独立危险因素。免疫疗法对复发患者仍然有益，但一部分患者可能进展为DRE。复发和慢性癫痫患者易发生皮质、颞叶和小脑萎缩。
