Open AccessSeizure semiology: an important clinical clue to the diagnosis of autoimmune epilepsy
Author(s) -
Lv RuiJuan,
Ren HaiTao,
Guan HongZhi,
Cui Tao,
Shao XiaoQiu
Publication year - 2018
Publication title -
annals of clinical and translational neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.824
H-Index - 42
ISSN - 2328-9503
DOI - 10.1002/acn3.520
Subject(s) - medicine , epilepsy , semiology , hippocampal sclerosis , autoantibody , pediatrics , temporal lobe , psychiatry , antibody , immunology
Objective The purpose of this study is to analyze the seizure semiologic characteristics of patients with autoimmune epilepsy ( AE ) and describe the investigation characteristics of AE using a larger sample size. Methods This observational retrospective case series study was conducted from a tertiary epilepsy center between May 2014 and March 2017. Cases of new‐onset seizures were selected based on laboratory evidence of autoimmunity. At the same time, typical mesial temporal lobe epilepsy ( MTLE ) patients with hippocampal sclerosis ( HS ) were recruited as the control group from the subjects who underwent presurgical evaluation during the same period. Results A total of 61 patients with AE were identified. Specific autoimmune antibodies were detected in 39 patients (63.93%), including anti‐ VGKC in 23 patients (37.70%), anti‐ NMDA ‐R in 9 patients (14.75%), anti‐ GABA B ‐R in 6 patients (9.84%), and anti‐amphiphysin in 1 patient (1.64%). Regarding the seizure semiology, no significant differences were noted between AE patients with autoantibody and patients with suspected AE without antibody. Compared to typical MTLE patients with HS , both AE patients with autoantibody and patients with suspected AE without antibody had the same seizure semiologic characteristics, including more frequent SPS or CPS , shorter seizure duration, rare postictal confusion, and common sleeping SGTC seizures. Significance This study highlights important seizure semiologic characteristics of AE . Patients with autoimmune epilepsy had special seizure semiologic characteristics. For patients with autoimmune epilepsy presenting with new‐onset seizures in isolation or with a seizure‐predominant neurological disorder, the special seizure semiologic characteristics may remind us to test neuronal nuclear/cytoplasmic antibodies early and initiate immunomodulatory therapies as soon as possible. Furthermore, the absence of neural‐specific autoantibodies does not rule out AE .