PDF(Pubmed)
Abstract：
Seizures are the main manifestation of the acute phase of autoimmune encephalitis (AE). Anti-seizure medications (ASMs) play an important role in controlling seizures in AE patients, but there is currently a lack of consensus regarding the selection, application, and discontinuation of ASMs. This narrative review focuses on the use of ASMs in patients with AE driven by different antibodies. The PubMed, Embase, and MEDLINE databases were searched up until 30 October 2022 using prespecified search terms. We identified 2,580 studies; 23 retrospective studies, 2 prospective studies and 9 case reports were evaluated based on our inclusion criteria. Anti-N-methyl-D-aspartic-acid-receptor (anti-NMDAR) encephalitis is the type of AE that responds best to ASMs, and long-term or combined use of ASMs may be not required in most patients with seizures; these results apply to both adults and children. Sodium channel blockers may be the best option for seizures in anti-leucine-rich-glioma-inactivated-1 (anti-LGI1) encephalitis, but patients with anti-LGI1 encephalitis are prone to side effects when using ASMs. Cell surface antibody-mediated AE patients are more likely to use ASMs for a long period than patients with intracellular antibody-mediated AE. Clinicians can score AE patients\' clinical characteristics on a scale to identify those who may require long-or short-term use of ASMs in the early stage. This review provides some recommendations for the rational use of ASMs in encephalitis mediated by different antibodies with the aim of controlling seizures and avoiding overtreatment.
摘要：
癫痫发作是自身免疫性脑炎（AE）急性期的主要表现。抗癫痫药物（ASM）在控制AE患者的癫痫发作中起着重要作用，但是目前在选择方面缺乏共识，应用程序,和停止ASM。这篇叙述性综述侧重于ASM在不同抗体驱动的AE患者中的使用。PubMed,Embase,和MEDLINE数据库使用预先指定的搜索词进行搜索，直到2022年10月30日。我们确定了2,580项研究；23项回顾性研究，根据我们的纳入标准评估了2项前瞻性研究和9例病例报告。抗N-甲基-D-天冬氨酸受体（抗NMDAR）脑炎是对ASM反应最好的AE类型，大多数癫痫患者可能不需要长期或联合使用ASM;这些结果适用于成人和儿童。钠通道阻滞剂可能是抗富含亮氨酸的神经胶质瘤灭活1（抗LGI1）脑炎癫痫发作的最佳选择，但是抗LGI1脑炎患者在使用ASM时容易出现副作用。细胞表面抗体介导的AE患者比细胞内抗体介导的AE患者更有可能长期使用ASM。临床医生可以对AE患者的临床特征进行评分，以确定早期可能需要长期或短期使用ASM的患者。这篇综述为在不同抗体介导的脑炎中合理使用ASM提供了一些建议，目的是控制癫痫发作和避免过度治疗。
