TY - JOUR
T1 - Evaluation of seizure treatment in anti-LGI1, anti-NMDAR, and anti-GABABR encephalitis
AU - de Bruijn, Marienke A. A. M.
AU - van Sonderen, Agnes
AU - van Coevorden-Hameete, Marleen H.
AU - Bastiaansen, Anna E. M.
AU - Schreurs, Marco W. J.
AU - Rouhl, Rob P. W.
AU - van Donselaar, Cees A.
AU - Majoie, Marian H. J. M.
AU - Neuteboom, Rinze F.
AU - Smitt, Peter A. E. Sillevis
AU - Thijs, Roland D.
AU - Titulaer, Maarten J.
PY - 2019/5/7
Y1 - 2019/5/7
N2 - ObjectiveThis nationwide cohort study evaluates seizure responses to immunotherapy and antiepileptic drugs (AEDs) in patients with anti-leucine-rich glioma-inactivated 1 (LGI1), anti-NMDA receptor (NMDAR), and anti-gamma-aminobutyric-acid B receptor (GABA(B)R) encephalitis.MethodsAnti-LGI1, anti-NMDAR, and anti-GABA(B)R encephalitis patients with new-onset seizures were included. Medical information about disease course, AEDs and immunotherapies used, effects, and side effects were collected. Outcome measures were (1) seizure freedom while using AEDs or immunotherapy, (2) days to seizure freedom from start of AEDs or immunotherapy, and (3) side effects.ResultsOf 153 patients with autoimmune encephalitis (AIE) (53 LGI1, 75 NMDAR, 25 GABABR), 72% (n = 110) had epileptic seizures, and 89% reached seizure freedom. At least 53% achieved seizure freedom shortly after immunotherapy, and 14% achieved seizure freedom while using only AEDs (p <0.0001). This effect was similar in all types (p = 0.0001; p = 0.0005; p = 0.013, respectively). Median time to seizure freedom from AEDs start was 59 days (interquartile range [IQR] 27-160), and 28 days from start of immunotherapy (IQR 9-71, p <0.0001). Side effects were psychotic behavior and suicidal thoughts by the use of levetiracetam, and rash by the use of carbamazepine. Carbamazepine was more effective than levetiracetam in reducing seizures in anti-LGI1 encephalitis (p = 0.031). Only 1 patient, of 86 surviving patients, developed epilepsy after resolved encephalitis.ConclusionEpilepsy after resolved encephalitis was rare in our cohort of patients with AIE treated with immunotherapy. In addition, seizure freedom is achieved faster and more frequently after immunotherapy. Therefore, AEDs should be considered as add-on treatment, and similar to treatment of other encephalitis symptoms, immunotherapy is crucial.
AB - ObjectiveThis nationwide cohort study evaluates seizure responses to immunotherapy and antiepileptic drugs (AEDs) in patients with anti-leucine-rich glioma-inactivated 1 (LGI1), anti-NMDA receptor (NMDAR), and anti-gamma-aminobutyric-acid B receptor (GABA(B)R) encephalitis.MethodsAnti-LGI1, anti-NMDAR, and anti-GABA(B)R encephalitis patients with new-onset seizures were included. Medical information about disease course, AEDs and immunotherapies used, effects, and side effects were collected. Outcome measures were (1) seizure freedom while using AEDs or immunotherapy, (2) days to seizure freedom from start of AEDs or immunotherapy, and (3) side effects.ResultsOf 153 patients with autoimmune encephalitis (AIE) (53 LGI1, 75 NMDAR, 25 GABABR), 72% (n = 110) had epileptic seizures, and 89% reached seizure freedom. At least 53% achieved seizure freedom shortly after immunotherapy, and 14% achieved seizure freedom while using only AEDs (p <0.0001). This effect was similar in all types (p = 0.0001; p = 0.0005; p = 0.013, respectively). Median time to seizure freedom from AEDs start was 59 days (interquartile range [IQR] 27-160), and 28 days from start of immunotherapy (IQR 9-71, p <0.0001). Side effects were psychotic behavior and suicidal thoughts by the use of levetiracetam, and rash by the use of carbamazepine. Carbamazepine was more effective than levetiracetam in reducing seizures in anti-LGI1 encephalitis (p = 0.031). Only 1 patient, of 86 surviving patients, developed epilepsy after resolved encephalitis.ConclusionEpilepsy after resolved encephalitis was rare in our cohort of patients with AIE treated with immunotherapy. In addition, seizure freedom is achieved faster and more frequently after immunotherapy. Therefore, AEDs should be considered as add-on treatment, and similar to treatment of other encephalitis symptoms, immunotherapy is crucial.
KW - FACIOBRACHIAL DYSTONIC SEIZURES
KW - RECEPTOR ENCEPHALITIS
KW - ILAE COMMISSION
KW - POSITION PAPER
KW - FOLLOW-UP
KW - IMMUNOTHERAPY
KW - EPILEPSY
KW - CLASSIFICATION
KW - AUTOIMMUNE
KW - DEFINITION
U2 - 10.1212/WNL.0000000000007475
DO - 10.1212/WNL.0000000000007475
M3 - Article
C2 - 30979857
VL - 92
SP - E2185-E2196
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 19
ER -