Long-term evolution and prognostic factors of epilepsy in limbic encephalitis with LGI1 antibodies.
Drug-resistant epilepsy
Faciobrachial dystonic seizures
LGI1 autoimmune encephalitis
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
28
11
2021
accepted:
25
04
2022
revised:
14
03
2022
pubmed:
21
5
2022
medline:
12
8
2022
entrez:
20
5
2022
Statut:
ppublish
Résumé
To characterize the evolution of epilepsy in patients with leucine-rich glioma inactivated 1 antibody-associated (LGI1ab) limbic encephalitis, including factors associated with drug-resistant epilepsy (DRE). Retrospective analysis of patients with LGI1 encephalitis managed at two tertiary epilepsy centers between 2005 and 2019 and whose samples were confirmed by the French Reference Center of Paraneoplastic Neurological Syndromes. Raw clinical, biological, EEG, and MRI data were reviewed. Two endpoints were defined: (i) Epilepsy remission: patients seizure free and in whom anti-seizure medications (ASM) have been stopped for at least 1 year at the last follow-up visit (ii) DRE: patients with persistent seizures at the last follow-up despite at least two ASM used at efficacious daily dose. 39 patients with LGI1 encephalitis were included with a median follow-up duration of 42 months (range 13-169). All of them reported seizures at the acute phase, with faciobrachial dystonic seizures (FBDS) in 23 (59%) and other focal seizures in 38 (97%), including 4 patients (10%) with de novo status epilepticus. At the last follow-up visit, 11 patients (28%) achieved epilepsy remission. Among the 28 patients with persistent epilepsy, eight (29%) fulfilled criteria of DRE. The only factor significantly associated with epilepsy remission was the time from clinical onset of the encephalitis to initiation of the first immunomodulatory treatment, with longer delay in patients with persistent epilepsy (7.5 ± 8.9 vs 2.4 ± 1.7 months, p = 0.006). Evolution to DRE was only driven by MRI evolution. Eight of the 15 patients (53%) who developed hippocampal atrophy (p = 0.007) also suffered from drug-resistant seizures at the last follow-up. In patients with LGI1 encephalitis, rapid initiation of immunomodulatory treatment favors long-term epilepsy remission. Evolution to DRE might primarily reflect the anatomical lesion of limbic structures. Determining what modalities of immune treatment may alter these outcomes requires prospective studies with long-term follow-up.
Identifiants
pubmed: 35595970
doi: 10.1007/s00415-022-11162-3
pii: 10.1007/s00415-022-11162-3
doi:
Substances chimiques
Antibodies
0
Autoantibodies
0
Intracellular Signaling Peptides and Proteins
0
LGI1 protein, human
0
anti-leucine-rich glioma-inactivated 1 autoantibody
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5061-5069Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
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