Clinical characteristics of autoimmune encephalitis patients with epileptic seizures as initial symptom
Objective To analyze the clinical characteristics of antibody-positive autoimmune encephalitis patients with epileptic seizures as initial symptom.Methods In this cross-sectional study,the medical records of 38 patients who were diagnosed with antibody-positive autoimmune encephalitis in the Zhongshan Hospital affiliated to Fudan University from April 2019 to January 2023 were collected.Demographic information,clinical symptoms,auxiliary examination,treatment protocols,immunotherapy time,and the incidence of seizures and the use of antiepileptic drugs one year after discharge were retrospectively analyzed.According to the location of antigen,the patients were divided into anti-cell surface antigen antibody group,anti-glial cell surface antigen antibody group,and anti-intracellular antigen antibody group.According to epileptic seizures as the initial symptom,the patients were divided into seizure as initial symptom group and non-seizure as initial symptom group.According to the result of follow-up,the patients were divided into acute symptomatic seizures group and epilepsy group.Results Among the patients,NMDAR antibody was positive in 11,LGI1 positive in 6,CASPR2 positive in 4,GFAP positive in 2,MOG positive in 2,GABABR,GlyR1,mGLuR2,PCA-2,NCDN,KLHL11,GAD65,Ri,and Hu positive in one each.There were one patient with GAD65+Hu+AMPA positive,2 patients with MDA+GFAP positive,one patient with CASPR2+LGI1 positive,and one patient with GABABR+AMPA positive.The incidence of seizures in anti-cell surface antigen antibody group was significantly higher than that in anti-intracellular antibody group(P=0.024).The patients in the anti-intracellular antibody group were older than those in the anti-cell surface antibody group and the glial cell surface antibody group,but no statistical differences were found(all P＞0.05).The abnormal signal in unilateral or bilateral temporal lobes was more common in the seizure as initial symptom group than that in the non-seizure as initial symptom group,epilepsy occurred in more patients in the seizure as initial symptom group than the non-seizure as initial symptom group,but the differences were not statistically significant(all P＞0.05).LGI1 positive was the most common in patients with epileptic seizure as initial symptom.LGI1 positive was the most common in patients with seizures during the course of the disease,followed by NMDAR positive.NMDAR positive was the most common in patients with acute symptomatic seizures.LGI1 antibody positive was the most common in patients with epilepsy.There were no significant differences in the age,cerebrospinal fluid antibody titer,treatment methods,or immunotherapy time between the acute symptomatic seizures group and the epilepsy group(all P＞0.05).Gamma globulin and corticosteroids were given in 20 patients,3 patients received gamma globulin+corticosteroids+plasmapheresis,6 patients received gamma globulin,and 6 patients received corticosteroids.Thirty-three patients were discharged due to improved condition,3 patients died,and 2 patients were discharged voluntarily during therapy.Conclusion Patients with epileptic seizure as initial symptom are more likely to have abnormal signals in the temporal lobe of brain MRI in the early stage,and develop epilepsy.The development of epilepsy may be related to the type of antibody.
万方数据
维普
