Seizure specificities in patients with antibody-mediated autoimmune encephalitis

Abstract

Accumulating data on patients with autoimmune encephalitis have shed light on specificities concerning clinical presentation and outcomes, which are dependent on the antigen targeted by the autoantibodies found in the patients' cerebrospinal fluid or sera. Such specificities include seizure-related clinical manifestations as well as the responsiveness to antiepileptic drugs. Although increased enthusiasm accompanies the discovery of novel antibodies and their associated clinical syndromes, several issues remain unsettled. First, it appears that therapy needs to be personalized in the view of the severity of each antibody-mediated syndrome, patient-related characteristics, and timing of treatment. Second, the lack of randomized controlled trials is a major drawback in the formulation of an appropriate immunotherapeutic strategy. In this review, we discuss the novel developments and challenges for the diagnosis and treatment of epilepsy in patients with well-characterized autoimmune encephalitis, and delineate the principles for a rational approach toward precision medicine in this emerging field.

Keywords: autoimmune diseases; electroencephalography; encephalitis; epilepsy; paraneoplastic syndromes; seizures.