Abstract：
BACKGROUND: Approximately 60% of patients with autoimmune encephalitis (AE) exhibit secondary acute symptomatic seizures and showed highly sensitive to immunotherapy. However, it is difficult for many patients to receive early immunotherapy since the early identification of the cause in AE is more complex. This study aimed to investigate the early predictors of initial immune-related seizures and to guide the evaluation of treatment and prognosis.
METHODS: One hundred and fifty-four patients with new-onset \"unknown etiology\" seizures with a course of disease less than 6 months were included. Serum and/or cerebrospinal fluid neuron-specific autoantibodies (NSAbs), including N-methyl-D-aspartate receptor (NMDAR), α-amino-3-hydroxy-5- Methyl-4-isoxazole propionic acid receptor 1 (AMPAR1), AMPAR2, anti-leucine rich glioma inactivated 1 antibody (LGI1), anti-gamma-aminobutyric acid type B receptor (GABABR), anti-contact protein-related protein-2 (CASPR2) were used to screen for immune etiology of the seizures. In addition, patients with epilepsy and encephalopathy were also examined via brain MRI, long-term video EEG, antibody prevalence in epilepsy and encephalopathy (APE2) score, and modified Rankin Scale (mRS). A logistic regression model was used to analyze the early predictors of immune etiology.
RESULTS: Thirty-four cases (22.1%) were positive for NSAbs. Among all 154 patients, 23 cases of autoimmune encephalitis (AE) (21 cases of NSAbs positive), 1 case of ganglionic glioma (NSAbs positive), 130 cases of epilepsy or seizures (12 cases of NSAbs positive) were recorded. Also, there were 17 patients (11.0%) with APE2 ≥ 4 points, and all of them met the clinical diagnosis of AE. The sensitivity and specificity of APE2 ≥ 4 points for predicting AE were 73.9% and 100%. The results of multivariate analysis showed that the NSAbs and APE2 scores independently influenced the early prediction of initial immune-related seizures (P < 0.05).
CONCLUSIONS: NSAbs and APE2 scores could act as early predictors of initial immune-related seizures.
METHODS: One hundred and fifty-four patients with new-onset \"unknown etiology\" seizures with a course of disease less than 6 months were included. Serum and/or cerebrospinal fluid neuron-specific autoantibodies (NSAbs), including N-methyl-D-aspartate receptor (NMDAR), α-amino-3-hydroxy-5- Methyl-4-isoxazole propionic acid receptor 1 (AMPAR1), AMPAR2, anti-leucine rich glioma inactivated 1 antibody (LGI1), anti-gamma-aminobutyric acid type B receptor (GABABR), anti-contact protein-related protein-2 (CASPR2) were used to screen for immune etiology of the seizures. In addition, patients with epilepsy and encephalopathy were also examined via brain MRI, long-term video EEG, antibody prevalence in epilepsy and encephalopathy (APE2) score, and modified Rankin Scale (mRS). A logistic regression model was used to analyze the early predictors of immune etiology.
RESULTS: Thirty-four cases (22.1%) were positive for NSAbs. Among all 154 patients, 23 cases of autoimmune encephalitis (AE) (21 cases of NSAbs positive), 1 case of ganglionic glioma (NSAbs positive), 130 cases of epilepsy or seizures (12 cases of NSAbs positive) were recorded. Also, there were 17 patients (11.0%) with APE2 ≥ 4 points, and all of them met the clinical diagnosis of AE. The sensitivity and specificity of APE2 ≥ 4 points for predicting AE were 73.9% and 100%. The results of multivariate analysis showed that the NSAbs and APE2 scores independently influenced the early prediction of initial immune-related seizures (P < 0.05).
CONCLUSIONS: NSAbs and APE2 scores could act as early predictors of initial immune-related seizures.
摘要：
背景：大约60%的自身免疫性脑炎（AE）患者表现出继发性急性症状性癫痫发作，并对免疫疗法表现出高度敏感性。然而,许多患者难以接受早期免疫治疗,因为早期识别AE的病因更为复杂.本研究旨在探讨初次免疫相关性癫痫发作的早期预测因素，并指导治疗和预后的评估。
方法：纳入154例病程小于6个月的新发“病因不明”癫痫患者。血清和/或脑脊液神经元特异性自身抗体（NSAb），包括N-甲基-D-天冬氨酸受体（NMDAR），α-氨基-3-羟基-5-甲基-4-异恶唑丙酸受体1(AMPAR1),AMPAR2，抗富亮氨酸胶质瘤灭活1抗体（LGI1），抗γ-氨基丁酸B型受体（GABABR），使用抗接触蛋白相关蛋白2(CASPR2)筛查癫痫的免疫病因.此外,癫痫和脑病患者也通过脑MRI检查，长期视频脑电图，癫痫和脑病抗体患病率（APE2）评分，和改良的兰金量表(mRS)。采用logistic回归模型分析免疫病因的早期预测因素。
结果：34例（22.1%）NSAb阳性。在所有154名患者中，自身免疫性脑炎（AE）23例（NSAb阳性21例），1例神经节胶质瘤（NSAb阳性），记录130例癫痫或癫痫发作（NSAb阳性12例）。此外，APE2≥4分的患者有17例（11.0%），均符合AE的临床诊断。APE2≥4点预测AE的敏感性和特异性分别为73.9%和100%。多因素分析结果显示,NSAbs和APE2评分独立影响初次免疫相关性癫痫发作的早期预测(P<0.05)。
结论：NSAb和APE2评分可作为初始免疫相关性癫痫发作的早期预测因子。
方法：纳入154例病程小于6个月的新发“病因不明”癫痫患者。血清和/或脑脊液神经元特异性自身抗体（NSAb），包括N-甲基-D-天冬氨酸受体（NMDAR），α-氨基-3-羟基-5-甲基-4-异恶唑丙酸受体1(AMPAR1),AMPAR2，抗富亮氨酸胶质瘤灭活1抗体（LGI1），抗γ-氨基丁酸B型受体（GABABR），使用抗接触蛋白相关蛋白2(CASPR2)筛查癫痫的免疫病因.此外,癫痫和脑病患者也通过脑MRI检查，长期视频脑电图，癫痫和脑病抗体患病率（APE2）评分，和改良的兰金量表(mRS)。采用logistic回归模型分析免疫病因的早期预测因素。
结果：34例（22.1%）NSAb阳性。在所有154名患者中，自身免疫性脑炎（AE）23例（NSAb阳性21例），1例神经节胶质瘤（NSAb阳性），记录130例癫痫或癫痫发作（NSAb阳性12例）。此外，APE2≥4分的患者有17例（11.0%），均符合AE的临床诊断。APE2≥4点预测AE的敏感性和特异性分别为73.9%和100%。多因素分析结果显示,NSAbs和APE2评分独立影响初次免疫相关性癫痫发作的早期预测(P<0.05)。
结论：NSAb和APE2评分可作为初始免疫相关性癫痫发作的早期预测因子。
