Seizure characteristics, treatment, and outcome in autoimmune synaptic encephalitis: A long-term study.
OBJECTIVES
The objective of this study was to report seizure characteristics, long-term outcome, and potential factors associated with persistent seizures in patients with autoimmune synaptic encephalitis (ASE).


METHOD
Clinical data and courses of 52 patients with ASE who presented with seizures at the Department of Neurology of the First Hospital of Jilin University from January 2015 to August 2017 were reviewed. Seizure outcomes were assessed with a median follow-up duration of 30 months (8-40 months).


RESULTS
Most patients (71.2%) presented with seizure at initial consultation; focal to bilateral tonic-clonic seizures (50.0%) were the most common type. The temporal lobe (73.5%) was the prominent region of seizure origin, which was incident with hippocampal lesions on magnetic resonance imaging (MRI) in 62.1% of the patients. Status epilepticus, subclinical seizures, and nonepileptic events were observed in 28.9%, 36.8%, and 28.9% of the patients, respectively. Twenty-seven out of the 43 followed-up patients (62.8%) exhibited seizure remission after initial immunotherapy. Others (37.2%) developed persistent seizures to different extents. Six out of 9 patients experienced additional seizure freedom because of antiepileptic drugs (AEDs); however, the seizures of the other three patients, with serious conditions, showed poor response. Patients with anti-N-methyl-d-aspartate receptor antibodies had a lower risk of developing persistent seizures than those with anti-leucine-rich glioma-inactivated 1 (LGI1) or anti-γ-aminobutyric acid receptor type B receptor (GABABR) antibodies (P = 0.001).


CONCLUSIONS
A complex of clinical and subclinical seizures, and nonepileptic events characterize ASE. Patients with anti-LGI1 or anti-GABABR antibodies have a higher risk of developing persistent seizures; AEDs are suitable for achieving additional seizure freedom, but not for patients with serious conditions. A few patients present with super-refractory epilepsy despite multiple treatments.
['Zhang|Wuqiong|W|', 'Wang|Xue|X|', 'Shao|Na|N|', 'Ma|Rui|R|', 'Meng|Hongmei|H|']
D000293:Adolescent D000328:Adult D000368:Aged D000927:Anticonvulsants D000069279:Drug Resistant Epilepsy D004660:Encephalitis D004830:Epilepsy, Tonic-Clonic D005260:Female D005500:Follow-Up Studies D050031:Hashimoto Disease D006624:Hippocampus D006801:Humans D007167:Immunotherapy D047908:Intracellular Signaling Peptides and Proteins D008137:Longitudinal Studies D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D018079:Receptors, GABA D012640:Seizures D013226:Status Epilepticus D013702:Temporal Lobe D016896:Treatment Outcome D055815:Young Adult
Treatment Outcome Autoimmune synaptic encephalitis Epilepsy