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Autoimmune Etiology in Certain Epilepsy Patients

JAMA Neurol; ePub 2017 Feb 6; Dubey, et al

Among adult patients with epilepsy of unknown etiology, a significant minority had detectable serum neurological autoantibodies (Abs), suggesting an autoimmune etiology, according to a recent study. Consecutive patients presenting to neurology services with new-onset epilepsy or established epilepsy of unknown etiology were identified. Of the 127 patients (68 males and 59 females) enrolled in the study, 15 were subsequently excluded after identification of an alternative diagnosis. Researchers found:

  • Serum Abs suggesting a potential autoimmune etiology were detected in 39 (34.8%) cases.
  • 32 patients (28.6%) had a single Ab marker.
  • Certain clinical features, such as autonomic dysfunction, neuropsychiatric changes, viral prodrome, faciobrachial dystonic spells or facial dyskinesias, and mesial temporal sclerosis abnormality on magnetic resonance imaging, correlated with seropositivity.
  • Patients who were Ab positive were more likely to have good seizure outcome than were patients with epilepsy of unknown etiology (15 of 23 [65.2%] vs 24 of 89 [27.0%]).

Citation:

Dubey D, Alqallaf A, Hays R, et al. Neurological autoantibody prevalence in epilepsy of unknown etiology. [Published online ahead of print February 6, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2016.5429.