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Review
. 2023;21(8):1714-1735.
doi: 10.2174/1570159X20666220706094651.

Epilepsy, Immunity and Neuropsychiatric Disorders

Francesco Fortunato  1 , Alessia Giugno  1 , Ilaria Sammarra  1 , Angelo Labate  2 , Antonio Gambardella  1   3
Affiliations
Review

Epilepsy, Immunity and Neuropsychiatric Disorders

Francesco Fortunato et al. Curr Neuropharmacol. 2023.

Abstract

Several studies have focused on the emerging role of immunity and inflammation in a wide range of neurological disorders. Autoimmune diseases involving central nervous system share well defined clinical features including epileptic seizures and additional neuropsychiatric symptoms, like cognitive and psychiatric disturbances. The growing evidence about the role of immunity in the pathophysiologic mechanisms underlying these conditions lead to the concept of autoimmune epilepsy. This relatively-new term has been introduced to highlight the etiological and prognostic implications of immunity in epileptogenesis. In this review, we aim to discuss the role of autoimmunity in epileptogenesis and its clinical, neurophysiological, neuroimaging and therapeutic implications. Moreover, we wish to address the close relationship between immunity and additional symptoms, particularly cognitive and psychiatric features, which deeply impact clinical outcomes in these patients. To assess these aspects, we first analyzed Rasmussen's encephalitis. Subsequently, we have covered autoimmune encephalitis, particularly those associated with autoantibodies against surface neuronal antigens, as these autoantibodies express a direct immune-mediated mechanism, different from those against intracellular antigens. Then, we discussed the connection between systemic immune disorders and neurological manifestations. This review aims to highlight the need to expand knowledge about the role of inflammation and autoimmunity in the pathophysiology of neurological disorders and the importance to early recognize these clinical entities. Indeed, early identification may result in faster recovery and a better prognosis.

Keywords: Epilepsy/seizures; autoimmune encephalitis; immunity; immunotherapy; neuro-inflammation; neuropsychiatric disorders.

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Conflict of interest statement

The authors declare no conflict of interest, financial or otherwise.

Figures

Fig. (1)
Fig. (1)
A 58-year-old woman with drug-resistant TLE and memory deficits. Brain MRI demonstrates bilateral hippocampal hyperintensities on T2-weighted images (A) with prominent left hippocampal atrophy (B). She also has an undifferentiated connective tissue disease and chronic auto-immune hepatitis, stage III. On liver biopsy, note the severe necro-inflammatory activity (red circles), fibrous septa and hepatocellular rosettes (Emat-Eos.20X) (C) and subversion of the acinar structure with segregation of noduliform areas of parenchyma (Gomori 10X) (D). Steroid therapy, in addition to ASMs, ameliorated control of epileptic seizures and resolved mild cognitive deficits. Inflammatory and immunological factors might contribute to epileptogenesis in TLE.
Fig. (2)
Fig. (2)
Brain MRI of two sisters with hemiconvulsion-hemiplegia syndrome (IHHS). Note the cortico-subcortical atrophy of the right hemisphere (A, B) in the 64-year-old proband, while the brain atrophy was contralateral and limited to the left hemisphere (C, D) in her 58-year-old sister.
See this image and copyright information in PMC

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