Year: 2024
Type: article
Study design: Observational Study
Abstract: Objective Identify factors associated with the development of seizures and whether, in addition to immunotherapy, the choice of antiseizure medication is associated with decreased time to electro-clinical seizure freedom in the acute phase of autoimmune encephalitis. Background Seizures are common in patients with AE, and guidelines suggest should be treated with a combination of immunotherapy and antiseizure medications. Design/Methods The electronic medical records of patients with probable or definite autoimmune encephalitis (2010-2021) were retrospectively analyzed, and patients with either clinical or electrographic seizures were classified as having acute symptomatic seizures secondary to autoimmune encephalitis. Electrographic and clinical features associated with the development of acute symptomatic seizures secondary to AE were incorporated into a logistic regression model using a stepwise forward selection model. For patients with acute seizures, a Cox hazard ratio mixed-effect model with time to electro-clinical seizure freedom as the event of interest was performed. Results Among the 102 patients with acute autoimmune encephalitis included, 74 patients (73%) had acute symptomatic seizures: 34 patients with clinical-only seizures, 2 with electrographic-only seizures, and 38 had a combination of clinical and electrographic seizures. Patients with focal slowing, interictal discharges, and periodic discharges were more likely to have electrographic seizures (especially when extra-temporal and with superimposed fast activity), and patients with cell-surface antibodies were more likely to develop either clinical or electrographic seizures after (adjusted odds ratio= 5.00; p =0.01). Patients with LGI1 encephalitis who received sodium channel blockers achieved electro-clinical seizure freedom more rapidly (p<0.05) compared with those on other agents. Conclusions Acute symptomatic seizures are common in patients with autoimmune encephalitis, especially in those with cell-surface autoantibodies. Anti-seizure medications plays a complementary role to immunotherapy to achieving earlier electro-clinical seizure freedom, especially in patients with LGI1 encephalitis.
Source: Neurology
Authors: Julien Hebert, Kiran Thakur, Hyunmi Choi, Hai Ethan Hoang, Lucy Jia, Carla Kim, John Budrow, Jieru Egeria Lin, Pallavi Juneja, Donald Langan, William Harris
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4403206823