Open AccessAntiepileptic drug therapy in autoimmune epilepsy associated with antibodies targeting the leucine‐rich glioma‐inactivated protein 1
Author(s) -
Feyissa Anteneh M.,
Lamb Christopher,
Pittock Sean J.,
Gadoth Avi,
McKeon Andrew,
Klein Christopher J.,
Britton Jeffrey W.
Publication year - 2018
Publication title -
epilepsia open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.247
H-Index - 16
ISSN - 2470-9239
DOI - 10.1002/epi4.12226
Subject(s) - medicine , levetiracetam , valproic acid , epilepsy , glioma , retrospective cohort study , immunotherapy , semiology , anesthesia , pediatrics , gastroenterology , psychiatry , cancer , cancer research
Summary Objective To characterize seizure semiology and the utility of antiepileptic drug (AED) therapy in leucine‐rich glioma inactivated‐1 ( LGI 1‐Ab) autoimmune epilepsy (AE) . Methods Patients with voltage‐gated potassium channel complex ( VGKC c) titers higher than 0.02 nmol/L who were evaluated between May 2008 and June 2016 at the 3 Mayo Clinic sites (Arizona, Florida, or Minnesota) were identified. We then performed a retrospective review of those who were LGI 1‐Ab positive and were treated for seizures. Results A total of 1,095 patients with VGKC c titers higher than 0.02 nmol/L were identified, in which 77 were LGI 1 positive. Of these, 56 patients with seizures were included in the analysis. Mean age at symptom onset was 62.9 years; 66% (n = 37) were male. The most common seizure semiology was focal faciobrachial dystonic seizures with preserved awareness ( FBDS ) (n = 35, 63%), followed by focal with impaired awareness ( FIA ) (n = 29, 52%), generalized tonic–clonic ( GTC s) (n = 28, 50%), and focal non‐motor seizures with preserved awareness (n = 28, 50%). The majority had more than one seizure type (n = 49, 88%; median = 2.5). Thirty‐eight patients (68%) became seizure free: 29 (76%) with immunotherapy, 3 (5%) with AED s alone, 2 (3%) with AED s before any immunotherapy, and 4 (7%) with AED s after immunotherapy. Levetiracetam (n = 47, 84%) and valproic acid (n = 21, 38%) were the most commonly used AED s, but neither were associated with seizure freedom. Sodium channel blocking ( NCB ) AED s were associated with seizure freedom in 4 patients compared to none treated with non‐ NCB AED s. Regardless of class, AED s prior to or apart from immunotherapy were associated with seizure freedom in only five patients (9%). In patients with FBDS , seizure freedom was more often associated with immunotherapy than AED s (20/30 vs. 3/34, p = 0.001). Significance Although FBDS are the most characteristic seizure type seen in LGI 1‐Ab AE , other seizure types including FIA and GTC s also occur. Immunotherapy was the treatment most frequently associated with seizure freedom in LGI 1‐Ab AE . In general, AED s seemed to confer a very low chance for seizure freedom, although AED s with NCB ‐blocking properties were associated with seizure freedom in a limited number. Levetiracetam in particular appears to be ineffective in this patient population.