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Review
. 2017 Jun;30(3):345-353.
doi: 10.1097/WCO.0000000000000449.

Seizures and risk of epilepsy in autoimmune and other inflammatory encephalitis

Marianna Spatola  1 , Josep Dalmau
Affiliations
Review

Seizures and risk of epilepsy in autoimmune and other inflammatory encephalitis

Marianna Spatola et al. Curr Opin Neurol. 2017 Jun.

Abstract

Purpose of review: The aim of this study was to assess the seizure manifestations and risk of epilepsy in encephalitis associated with antibodies against neuronal cell-surface (autoimmune encephalitis) or myelin-associated antigens, and to review several chronic epileptic disorders, including Rasmussen's encephalitis, fever-induced refractory epileptic syndromes (FIRES) and new-onset refractory status epilepticus (NORSE).

Recent findings: Seizures are a frequent manifestation of autoimmune encephalitis. Some autoimmune encephalitis may associate with characteristic features: faciobrachial dystonic seizures (anti-LGI1 encephalitis), electroencephalogram extreme delta brush (anti-NMDAR) or multifocal FLAIR-MRI abnormalities (anti-GABAAR). In anti-LGI1 encephalitis, cortical, limbic and basal ganglia dysfunction results in different types of seizures. Autoimmune encephalitis or myelin-antibody associated syndromes are often immunotherapy-responsive and appear to have a low risk for chronic epilepsy. In contrast patients with seizures related to GAD65-antibodies (an intracellular antigen) frequently develop epilepsy and have suboptimal response to treatment (including surgery). Rasmussen's encephalitis or FIRES may occur with autoantibodies of unclear significance and rarely respond to immunotherapy. A study of patients with NORSE showed that 30% developed chronic epilepsy.

Summary: Although seizures are frequent in all types of autoimmune encephalitis, the risk for chronic epilepsy is dependent on the antigen: lower if located on the cell-surface, and higher if intracellular. For other disorders (Rasmussen's encephalitis, FIRES, NORSE), the prognosis remains poor.

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Conflict of interest statement

Conflicts of interest

Dr Dalmau receives royalties from Athena Diagnostics for the use of Ma-2 as an autoantibody test and from Euroimmun for the use of NMDAR, GABABR, GABAAR, DPPX and IgLON5 as autoantibody tests; he has received an unrestricted research grant from Euroimmun.

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MeSH terms

Supplementary concepts