Materiały źródłowe

• #1 Autoimmune Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/autoimmune-epilepsy/30185/

  A newly recognized category of epilepsy caused by or associated with antibodies. […] In 2017, the International League Against Epilepsy (ILAE) recognized an epilepsy resulting directly from an immune disorder with seizures as a core symptom. […] For an epilepsy to meet this classification, evidence of autoimmune-mediated central nervous system (CNS) inflammation is required. […] Autoimmune epilepsy is a general term for epilepsy mediated by or associated with antibodies sometimes linked to cancer. […] Paraneoplastic epilepsy is a subset of autoimmune epilepsy, always associated with an underlying tumor or cancer, in which antigens shared by normal neurons and cancer cells are presented to the immune system resulting in antibody production. […] When considering a diagnosis of autoimmune epilepsy, a critical detail to keep in mind is that some antibodies target intracellar antigens, while others target neural surface antigens.

• #2 Autoimmune Epilepsy

  https://practicalneurology.com/articles/2018-oct/autoimmune-epilepsy

  A newly recognized category of epilepsy caused by or associated with antibodies. Approximately 30% of patients with epilepsy do not achieve seizure freedom despite medical therapy, and the etiology of many epilepsies remains unknown. In 2017, the International League Against Epilepsy (ILAE) recognized an epilepsy resulting directly from an immune disorder with seizures as a core symptom. For an epilepsy to meet this classification, evidence of autoimmune-mediated central nervous system (CNS) inflammation is required. Currently, no strict diagnostic guidelines exist for autoimmune epilepsy. Autoimmune epilepsy is a general term for epilepsy mediated by or associated with antibodies sometimes linked to cancer. Antibodies to intracellular antigens have a high association with cancer (80%) such as ANNA-1 (Anti-Hu), PCA-1 (Anti-Yo), Anti-Ma1, and Anti-Ma2 (Ta). Such antibodies are often thought of as an epiphenomenon of T-cell-mediated neural tissue destruction because the antibodies are not directly causing the underlying neurologic disease. In contrast, antibodies to neural surface antigens are thought to directly cause neurologic disease, show a more robust response to immunotherapy, and have a more variable association with cancer. Typically, there is no history of epilepsy or seizure risk factors in the patient’s medical or family history. There can be a personal or family history of autoimmune disease that is organ or non-organ specific or cancer (particularly those strongly associated with autoimmune disease including SCLC, thymoma, teratoma, or lymphoma). Seizures of autoimmune epilepsy are most commonly focal temporal lobe seizures but seizure onset is often seen elsewhere. If there is a positive antibody result, cancer screening for the most common associated cancer type should be done. If antibody testing is negative, ovarian or testicular ultrasound and thoracic, abdominal/pelvic CT and full body PET scans are reasonable follow-up tests. Early diagnosis and treatment can drastically alter the course of the disease.

• #3 Autoimmune causes of seizures and epilepsy | Encephalitis International

  https://www.encephalitis.info/news/autoimmune-causes-of-seizures-and-epilepsy/

  There are many causes of seizures and epilepsy. However, it is only relatively recently that it has been found that the bodys own defence system can be a cause. […] In 2017, the International League Against Epilepsy (ILAE) officially added autoimmune conditions as a possible cause for seizures in some patients. […] While it is uncertain how many people with regular epilepsy have an autoimmune cause, we do know that around 75% of people with AE will have at least one seizure during their illness. […] Overall, we have made remarkable progress in understanding and treating seizures caused by autoimmune conditions.

• #4 Unraveling Autoimmune Epilepsy

  https://www.neurologylive.com/view/unraveling-autoimmune-epilepsy

  Autoimmune epilepsy is essentially a seizure disorder where a neural-specific antibody is present, may be pathogenic, and may cause seizures, said Lindsay Higdon, MD, a neurologist and epilepsy specialist at Jefferson University Hospital in Philadelphia, Pennsylvania. […] In one study, experts found that approximately 20% of unexplained epilepsy cases had evidence of circulating neural antibodies, suggesting an autoimmune cause. […] Over the past decade, several neural surface antigens and intracellular antigens have been found and documented in patients presenting with epilepsy, and in 2017, autoimmune epilepsy was officially recognized as a distinct entity by the International League Against Epilepsy. […] One of the main hallmarks of autoimmune epilepsy is that it is generally resistant to antiepileptic drugs. In a systematic review of 6 studies that included 169 patients with autoimmune epilepsy, antiepileptic drugs were effective in only 10.7% of cases.

• #5 Identification and Treatment of Autoimmune Epilepsy – Contemporary Advances in Epilepsy

  https://www.medpagetoday.com/resource-centers/contemporary-advances-epilepsy/identification-and-treatment-autoimmune-epilepsy/2088

  Among the one-third of adults with epilepsy of unknown etiology, an autoimmune cause appears to be the potential culprit in at least 20% of cases, according to new research published by Divyanshu Dubey, MD, and colleagues in JAMA Neurology. […] Among 112 consecutive adult patients with unexplained epilepsy, 20.5% were found to have neurologic antibodies strongly suggesting an autoimmune etiology. […] It’s now a recognized and accepted fact that a proportion of patients with new-onset epilepsy can have an autoimmune etiology. […] The primary aim of the Dubey et al. study was to determine the prevalence of neurologic autoantibodies among adult patients with new-onset or established epilepsy of unknown etiology. […] However, because some of the antibodies tested can be found in association with other neurological conditions, the investigators narrowed the antibody search to include only those targeting the N-methyl-D-aspartate receptor (NMDAR), the voltage-gated potassium channel complex (VGCc), leucine-rich glioma-inactivated protein 1 (LGI1), high-titer glutamic acid decarboxylase 65 (GAD65), and antineuronal nuclear antibody type 1 (ANNA-1 or anti-Hu).

• #6 What causes seizures in adults with no history?

  https://www.moleculera.com/seizures-adults-with-no-history/

  Autoimmune factors may play a bigger role in seizure disorders than previously suspected. […] But now, studies indicate that an autoimmune cause appears to be the potential culprit in at least 20% of [those] cases. […] Mounting evidence also indicates that an immune dysfunction or abnormal autoimmune activity can elicit a sudden onset of seizures in adults with no history of the illness. […] Its well-established that people with certain autoimmune disorders, such as lupus, type 1 diabetes, celiac disease, multiple sclerosis, rheumatoid arthritis, and psoriasis, are at greater risk of developing epileptic seizures. […] Investigators from Mayo Clinic point out, Its now a recognized and accepted fact that a proportion of patients with new-onset epilepsy can have an autoimmune etiology.

• #7 Clinical Approach to Autoimmune Epilepsy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7541993/

  Autoimmune epilepsy is a newly emerging area of epilepsy. The concept of autoimmune as an etiology has recently been revisited thanks to advances in autoimmune encephalitis and precision medicine with immunotherapies. […] Autoimmune epilepsy is a group of epilepsies mediated by all kinds of autoimmune reactions. Most cases of autoimmune epilepsy consist of autoimmune limbic encephalitis, with inflammation of the limbic area causing seizure, memory loss, unconsciousness, and psychiatric symptoms. […] Autoimmune epilepsy can be associated with a tumor as a paraneoplastic syndrome, but association with an incidental tumor is also common. […] A multicenter study found the NORSE etiology in about half of the patients (47%), with autoimmune etiologies (37%, comprising 19% nonparaneoplastic and 18% paraneoplastic) being more common than infection (8%). These results indicate that an autoimmune pathogenesis is much more likely than a viral infection in NORSE.

• #8 :: JCN :: Journal of Clinical Neurology

  https://thejcn.com/DOIx.php?id=10.3988/jcn.2020.16.4.519

  Autoimmune epilepsy is a newly emerging area of epilepsy. The concept of autoimmune as an etiology has recently been revisited thanks to advances in autoimmune encephalitis and precision medicine with immunotherapies. […] Autoimmune epilepsy is a group of epilepsies mediated by all kinds of autoimmune reactions. Most cases of autoimmune epilepsy consist of autoimmune limbic encephalitis, with inflammation of the limbic area causing seizure, memory loss, unconsciousness, and psychiatric symptoms. […] Autoimmune epilepsy can be associated with a tumor as a paraneoplastic syndrome, but association with an incidental tumor is also common. […] A multicenter study found the NORSE etiology in about half of the patients (47%), with autoimmune etiologies (37%, comprising 19% nonparaneoplastic and 18% paraneoplastic) being more common than infection (8%). These results indicate that an autoimmune pathogenesis is much more likely than a viral infection in NORSE. Therefore, after performing a thorough evaluation of infection, it is possible to consider NORSE as potentially autoimmune epilepsy requiring active immunotherapy.

• #9 Mayo Clinic Health Library – Autoimmune epilepsy | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20573820

  Autoimmune epilepsy is a type of epilepsy where seizures are caused by the immune system mistakenly attacking brain cells. […] Autoimmune epilepsy is caused by the immune system attacking brain cells and leading to seizures. Antibodies are part of the immune system. They usually protect the body from viruses and infections. But in autoimmune conditions, the immune system attacks healthy cells. More recently, research has concluded that epilepsy can be an autoimmune disease. […] Autoimmune epilepsy causes may include: Autoimmune encephalitis. Autoimmune encephalitis (en-sef-uh-LIE-tis) is a group of conditions that causes swelling in the brain. This happens because the immune system mistakenly attacks brain cells. Autoimmune encephalitis causes a variety of symptoms, including seizures. It is the most common cause of autoimmune epilepsy. Certain types of autoimmune encephalitis are commonly linked to autoimmune epilepsy and are associated with antibodies that target NMDA-receptors, LGI1, CASPR2 and GAD65.

• #10 Autoimmune epilepsy | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/autoimmune-epilepsy?content_id=CON-20573820

  Autoimmune epilepsy is a type of epilepsy where seizures are caused by the immune system mistakenly attacking brain cells. […] Autoimmune epilepsy is caused by the immune system attacking brain cells and leading to seizures. Antibodies are part of the immune system. They usually protect the body from viruses and infections. But in autoimmune conditions, the immune system attacks healthy cells. More recently, research has concluded that epilepsy can be an autoimmune disease. […] Autoimmune encephalitis is a group of conditions that causes swelling in the brain. This happens because the immune system mistakenly attacks brain cells. Autoimmune encephalitis causes a variety of symptoms, including seizures. It is the most common cause of autoimmune epilepsy. Certain types of autoimmune encephalitis are commonly linked to autoimmune epilepsy and are associated with antibodies that target NMDA-receptors, LGI1, CASPR2 and GAD65. […] Rasmussen syndrome, which mainly affects children, usually doesn’t respond to medicines. Brain surgery often is needed to treat this type of autoimmune epilepsy.

• #11 Autoimmune epilepsy | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/autoimmune-epilepsy

  Autoimmune epilepsy is caused by the immune system attacking brain cells and leading to seizures. Antibodies are part of the immune system. They usually protect the body from viruses and infections. But in autoimmune conditions, the immune system attacks healthy cells. More recently, research has concluded that epilepsy can be an autoimmune disease. […] Autoimmune epilepsy causes may include: […] Autoimmune encephalitis is a group of conditions that causes swelling in the brain. This happens because the immune system mistakenly attacks brain cells. Autoimmune encephalitis causes a variety of symptoms, including seizures. It is the most common cause of autoimmune epilepsy. Certain types of autoimmune encephalitis are commonly linked to autoimmune epilepsy and are associated with antibodies that target NMDA-receptors, LGI1, CASPR2 and GAD65.

• #12 Mayo Clinic Health Library – Autoimmune epilepsy | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20573820

  Autoimmune epilepsy is a type of epilepsy where seizures are caused by the immune system mistakenly attacking brain cells. […] Autoimmune epilepsy is caused by the immune system attacking brain cells and leading to seizures. Antibodies are part of the immune system. They usually protect the body from viruses and infections. But in autoimmune conditions, the immune system attacks healthy cells. More recently, research has concluded that epilepsy can be an autoimmune disease. […] Autoimmune epilepsy causes may include: Autoimmune encephalitis. Autoimmune encephalitis (en-sef-uh-LIE-tis) is a group of conditions that causes swelling in the brain. This happens because the immune system mistakenly attacks brain cells. Autoimmune encephalitis causes a variety of symptoms, including seizures. It is the most common cause of autoimmune epilepsy. Certain types of autoimmune encephalitis are commonly linked to autoimmune epilepsy and are associated with antibodies that target NMDA-receptors, LGI1, CASPR2 and GAD65.

• #13 Autoimmune Epilepsy: New Development and Future Directions | IntechOpen

  https://www.intechopen.com/chapters/57010

  The action mechanism proposed for these factors is based on the release of pro-inflammatory substances inducing the danger signals expression and the consequent activation of auto-reactive T lymphocyte clones. […] Nevertheless, infections can also modify the clinical manifestations associated with autoimmune epilepsy (AE) in such a way that infections are involved in the induction and protection of AEs in genetically predisposed individuals. […] The target antigens that play a critical role in neuronal transmission and in plasticity include the N-methyl-D-aspartate (NMDA) receptor, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), the gamma-aminobutyric acid receptor (GABA), the glioma-inactivating leucine-rich protein (LGI1) and the contacting-associated protein 2 (CASPR2).

• #14 Autoimmune Epilepsy: New Development and Future Directions | IntechOpen

  https://www.intechopen.com/chapters/57010

  In NMDARAS, IgG antibodies are directed to the N-terminal extracellular domain of the GluN1 subunit of the NMDA receptor; the cultures of dissociated rat hippocampal neurons and antibody-containing cerebrospinal fluid (CSF) from patients with NMDARAS have been used to study the molecular mechanism by which IgG antibodies cause hypo function of the NMDAR. […] Encephalitis associated with antibodies against GABAB1 receptor is generally presented as limbic encephalitis, as well as drug-refractory seizures. […] The presence of autoantibodies against these receptors has been associated with seizures and changes in memory and behavior. […] Antibodies to the AMPAR have recently been described in patients with limbic encephalitis (LE). […] GAD antibodies act as a marker of the underlying autoimmune disease, although it is not known how antibodies against an intracellular enzyme can directly initiate pathological events; however, it is known that anti-GAD Abs inhibit the activity of GAD, and the synthesis of GABA antibodies to GAD is associated with several autoimmune disorders, including limbic encephalitis. […] Studies describing treatment of LGI1-antibody associated encephalopathy, LGI1 is a protein secreted by neurons that interact with pre- and postsynaptic receptors.

• #15 Autoimmune Epilepsy – The Defeating Epilepsy Foundation

  https://www.defeatingepilepsy.org/understanding-epilepsy/autoimmune-epilepsy/

  Autoimmune epilepsy is a group of epilepsies mediated by all kinds of autoimmune reactions (Jang et. al., 2020). There are a number of autoimmune conditions that lead to the individual having seizure activity. […] Many of the cases of autoimmune epilepsy involve autoimmune limbic encephalitis. Autoimmune limbic encephalitis is defined as an inflammatory disease involving the medial temporal lobes, resulting in short-term memory deficits, seizures, or psychiatric symptoms (Budhram et. al, 2019). […] There are many situations that can cause autoimmune epilepsy. […] Symptoms that are caused by autoimmune limbic encephalitis include altered mental status, psychiatric symptoms, or memory deficits (Jang et. al., 2020). […] Tumors can cause symptoms of autoimmune epilepsy. […] Autoimmune epilepsy is treated by immunotherapy, removal of an immunologic trigger such as a tumor (when one is present) and anti-epileptic medications (Husari and Dubey, 2019). […] Many cases of autoimmune epilepsy involve autoimmune limbic encephalitis.

• #16 Autoimmune Epilepsy

  https://www.integrisneuro.com/post/autoimmune-epilepsy

  But for some these antibodies that target the brain may be the cause of autoimmune epilepsy. […] Patients that have a history of another autoimmune disease or a parent with an autoimmune disease are often at most risk for this condition and patients with a sudden or severe onset of seizures should be considered as having an autoimmune cause. […] Autoimmune Epilepsy often begins with seizures developing over days to weeks following an illness. […] Some common types of Autoimmune Epilepsy include: […] Autoimmune limbic encephalitis: The most common type of autoimmune epilepsy, it’s caused by inflammation of the limbic area of the brain. Symptoms include seizures, memory loss, unconsciousness, and psychiatric symptoms.

• #17 Mayo Clinic Health Library – Autoimmune epilepsy | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20573820

  Rasmussen syndrome. In this condition, immune cells known as T cells cause inflammation and brain damage that lead to seizures. People with autoimmune epilepsy due to Rasmussen syndrome may continue to have seizures after treatment. […] Cancer. Sometimes tumors trigger the immune system to attack healthy brain cells, known as paraneoplastic syndrome. This can lead to epilepsy.

• #18 Autoimmune epilepsy | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/autoimmune-epilepsy?content_id=CON-20573820

  Autoimmune epilepsy is a type of epilepsy where seizures are caused by the immune system mistakenly attacking brain cells. […] Autoimmune epilepsy is caused by the immune system attacking brain cells and leading to seizures. Antibodies are part of the immune system. They usually protect the body from viruses and infections. But in autoimmune conditions, the immune system attacks healthy cells. More recently, research has concluded that epilepsy can be an autoimmune disease. […] Autoimmune encephalitis is a group of conditions that causes swelling in the brain. This happens because the immune system mistakenly attacks brain cells. Autoimmune encephalitis causes a variety of symptoms, including seizures. It is the most common cause of autoimmune epilepsy. Certain types of autoimmune encephalitis are commonly linked to autoimmune epilepsy and are associated with antibodies that target NMDA-receptors, LGI1, CASPR2 and GAD65. […] Rasmussen syndrome, which mainly affects children, usually doesn’t respond to medicines. Brain surgery often is needed to treat this type of autoimmune epilepsy.

• #19 Rasmussen’s Encephalitis: What It Is, Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/6092-rasmussens-encephalitis

  Scientists dont know the cause of Rasmussens encephalitis, but they have two theories: […] Autoimmune disease: An autoimmune disease happens when your immune system attacks healthy tissue for unknown reasons. Researchers think Rasmussens encephalitis may be an autoimmune condition that affects one side of your brain. […] Infection: Rasmussens encephalitis may be the result of an unknown virus entering your brain. However, researchers havent identified a specific virus despite careful studies of the affected brains.

• #20 Autoimmune Epilepsy: New Development and Future Directions | IntechOpen

  https://www.intechopen.com/chapters/57010

  In epilepsy, there are no studies associating autoimmunity with genetic factors; however, studies have focused on other autoimmune diseases and focuses are mainly associated with major histocompatibility system. […] The HLA system has two fundamental properties that make it difficult to understand, the genes involved in the predisposition to AEs: polymorphism and linkage disequilibrium (LD). […] Genetic study with a cohort of 24 cases of Rasmussen (RE) autoimmune encephalitis, the human leukocyte antigen (HLA) class I and class II genes were sequenced; they got the association of three C*07 alleles: 02:01:01, DQA1*04:01:01, and DQB1*04:02:01, that increased the relative risk of RE. […] The same way, anti-leucine-rich glioma-inactivated (LGI1) encephalitis was associated with the DRB1*07:01-DQB1*02:02 haplotype in HLA class II genes, as well as with B*44:03 and C*07:06 in the HLA class I region.

• #21 Mayo Clinic Health Library – Autoimmune epilepsy | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20573820

  Rasmussen syndrome. In this condition, immune cells known as T cells cause inflammation and brain damage that lead to seizures. People with autoimmune epilepsy due to Rasmussen syndrome may continue to have seizures after treatment. […] Cancer. Sometimes tumors trigger the immune system to attack healthy brain cells, known as paraneoplastic syndrome. This can lead to epilepsy.

• #22 Autoimmune epilepsy: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/autoimmune-epilepsy

  Autoimmune epilepsy is a rare type of epilepsy that occurs as a result of an immune system imbalance. It develops due to immune antibodies targeting the brain. […] One potential cause of epilepsy is the immune systems activity damaging the brain. However, this is rare. […] A 2020 study defined that autoimmune epilepsy refers to different diseases, but they all cause chronic seizures and the ongoing presence of antibodies that target brain proteins. […] The condition develops when certain antibodies target specific receptors in the brain. It is not clear whether these antibodies have any beneficial function or exactly why they develop. […] Sometimes, these antibodies relate to a tumor, in which case a doctor refers to them as paraneoplastic. […] Systemic autoimmune disorders (SADs) affect the whole body rather than just the brain. However, people with these types of conditions especially lupus and rheumatoid arthritis might have a higher risk of epilepsy, according to a 2021 review.

• #23 Autoimmune Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/autoimmune-epilepsy/30185/

  A newly recognized category of epilepsy caused by or associated with antibodies. […] In 2017, the International League Against Epilepsy (ILAE) recognized an epilepsy resulting directly from an immune disorder with seizures as a core symptom. […] For an epilepsy to meet this classification, evidence of autoimmune-mediated central nervous system (CNS) inflammation is required. […] Autoimmune epilepsy is a general term for epilepsy mediated by or associated with antibodies sometimes linked to cancer. […] Paraneoplastic epilepsy is a subset of autoimmune epilepsy, always associated with an underlying tumor or cancer, in which antigens shared by normal neurons and cancer cells are presented to the immune system resulting in antibody production. […] When considering a diagnosis of autoimmune epilepsy, a critical detail to keep in mind is that some antibodies target intracellar antigens, while others target neural surface antigens.

• #24 Autoimmune Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/autoimmune-epilepsy/30185/

  Antibodies to intracellular antigens have a high association with cancer (80%) such as ANNA-1 (Anti-Hu), PCA-1 (Anti-Yo), Anti-Ma1, and Anti-Ma2 (Ta). […] In contrast, antibodies to neural surface antigens are thought to directly cause neurologic disease, show a more robust response to immunotherapy, and have a more variable association with cancer. […] Recommendations for tumor screening are antibody specific and covered later in this article, although often a specific antibody is not detected. […] When no specific antibody is detected, the clinical features and other test results guide diagnosis of autoimmune epilepsy, and broad cancer screening is also performed. […] Seizures of autoimmune epilepsy are most commonly focal temporal lobe seizures but seizure onset is often seen elsewhere.

• #25 Autoimmune Epilepsy

  https://practicalneurology.com/articles/2018-oct/autoimmune-epilepsy

  A newly recognized category of epilepsy caused by or associated with antibodies. Approximately 30% of patients with epilepsy do not achieve seizure freedom despite medical therapy, and the etiology of many epilepsies remains unknown. In 2017, the International League Against Epilepsy (ILAE) recognized an epilepsy resulting directly from an immune disorder with seizures as a core symptom. For an epilepsy to meet this classification, evidence of autoimmune-mediated central nervous system (CNS) inflammation is required. Currently, no strict diagnostic guidelines exist for autoimmune epilepsy. Autoimmune epilepsy is a general term for epilepsy mediated by or associated with antibodies sometimes linked to cancer. Antibodies to intracellular antigens have a high association with cancer (80%) such as ANNA-1 (Anti-Hu), PCA-1 (Anti-Yo), Anti-Ma1, and Anti-Ma2 (Ta). Such antibodies are often thought of as an epiphenomenon of T-cell-mediated neural tissue destruction because the antibodies are not directly causing the underlying neurologic disease. In contrast, antibodies to neural surface antigens are thought to directly cause neurologic disease, show a more robust response to immunotherapy, and have a more variable association with cancer. Typically, there is no history of epilepsy or seizure risk factors in the patient’s medical or family history. There can be a personal or family history of autoimmune disease that is organ or non-organ specific or cancer (particularly those strongly associated with autoimmune disease including SCLC, thymoma, teratoma, or lymphoma). Seizures of autoimmune epilepsy are most commonly focal temporal lobe seizures but seizure onset is often seen elsewhere. If there is a positive antibody result, cancer screening for the most common associated cancer type should be done. If antibody testing is negative, ovarian or testicular ultrasound and thoracic, abdominal/pelvic CT and full body PET scans are reasonable follow-up tests. Early diagnosis and treatment can drastically alter the course of the disease.

• #26 Clinical Approach to Autoimmune Epilepsy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7541993/

  Autoimmune epilepsy is a newly emerging area of epilepsy. The concept of autoimmune as an etiology has recently been revisited thanks to advances in autoimmune encephalitis and precision medicine with immunotherapies. […] Autoimmune epilepsy is a group of epilepsies mediated by all kinds of autoimmune reactions. Most cases of autoimmune epilepsy consist of autoimmune limbic encephalitis, with inflammation of the limbic area causing seizure, memory loss, unconsciousness, and psychiatric symptoms. […] Autoimmune epilepsy can be associated with a tumor as a paraneoplastic syndrome, but association with an incidental tumor is also common. […] A multicenter study found the NORSE etiology in about half of the patients (47%), with autoimmune etiologies (37%, comprising 19% nonparaneoplastic and 18% paraneoplastic) being more common than infection (8%). These results indicate that an autoimmune pathogenesis is much more likely than a viral infection in NORSE.

• #27 :: JCN :: Journal of Clinical Neurology

  https://thejcn.com/DOIx.php?id=10.3988/jcn.2020.16.4.519

  Autoimmune epilepsy is a newly emerging area of epilepsy. The concept of autoimmune as an etiology has recently been revisited thanks to advances in autoimmune encephalitis and precision medicine with immunotherapies. […] Autoimmune epilepsy is a group of epilepsies mediated by all kinds of autoimmune reactions. Most cases of autoimmune epilepsy consist of autoimmune limbic encephalitis, with inflammation of the limbic area causing seizure, memory loss, unconsciousness, and psychiatric symptoms. […] Autoimmune epilepsy can be associated with a tumor as a paraneoplastic syndrome, but association with an incidental tumor is also common. […] A multicenter study found the NORSE etiology in about half of the patients (47%), with autoimmune etiologies (37%, comprising 19% nonparaneoplastic and 18% paraneoplastic) being more common than infection (8%). These results indicate that an autoimmune pathogenesis is much more likely than a viral infection in NORSE. Therefore, after performing a thorough evaluation of infection, it is possible to consider NORSE as potentially autoimmune epilepsy requiring active immunotherapy.

• #28 Autoimmune Epilepsy

  https://practicalneurology.com/articles/2018-oct/autoimmune-epilepsy

  A newly recognized category of epilepsy caused by or associated with antibodies. Approximately 30% of patients with epilepsy do not achieve seizure freedom despite medical therapy, and the etiology of many epilepsies remains unknown. In 2017, the International League Against Epilepsy (ILAE) recognized an epilepsy resulting directly from an immune disorder with seizures as a core symptom. For an epilepsy to meet this classification, evidence of autoimmune-mediated central nervous system (CNS) inflammation is required. Currently, no strict diagnostic guidelines exist for autoimmune epilepsy. Autoimmune epilepsy is a general term for epilepsy mediated by or associated with antibodies sometimes linked to cancer. Antibodies to intracellular antigens have a high association with cancer (80%) such as ANNA-1 (Anti-Hu), PCA-1 (Anti-Yo), Anti-Ma1, and Anti-Ma2 (Ta). Such antibodies are often thought of as an epiphenomenon of T-cell-mediated neural tissue destruction because the antibodies are not directly causing the underlying neurologic disease. In contrast, antibodies to neural surface antigens are thought to directly cause neurologic disease, show a more robust response to immunotherapy, and have a more variable association with cancer. Typically, there is no history of epilepsy or seizure risk factors in the patient’s medical or family history. There can be a personal or family history of autoimmune disease that is organ or non-organ specific or cancer (particularly those strongly associated with autoimmune disease including SCLC, thymoma, teratoma, or lymphoma). Seizures of autoimmune epilepsy are most commonly focal temporal lobe seizures but seizure onset is often seen elsewhere. If there is a positive antibody result, cancer screening for the most common associated cancer type should be done. If antibody testing is negative, ovarian or testicular ultrasound and thoracic, abdominal/pelvic CT and full body PET scans are reasonable follow-up tests. Early diagnosis and treatment can drastically alter the course of the disease.

• #29 Autoimmune Epilepsy

  https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/autoimmune-epilepsy/30185/

  Antibodies to intracellular antigens have a high association with cancer (80%) such as ANNA-1 (Anti-Hu), PCA-1 (Anti-Yo), Anti-Ma1, and Anti-Ma2 (Ta). […] In contrast, antibodies to neural surface antigens are thought to directly cause neurologic disease, show a more robust response to immunotherapy, and have a more variable association with cancer. […] Recommendations for tumor screening are antibody specific and covered later in this article, although often a specific antibody is not detected. […] When no specific antibody is detected, the clinical features and other test results guide diagnosis of autoimmune epilepsy, and broad cancer screening is also performed. […] Seizures of autoimmune epilepsy are most commonly focal temporal lobe seizures but seizure onset is often seen elsewhere.

• #30 Autoimmune Epilepsy

  https://practicalneurology.com/articles/2018-oct/autoimmune-epilepsy

  A newly recognized category of epilepsy caused by or associated with antibodies. Approximately 30% of patients with epilepsy do not achieve seizure freedom despite medical therapy, and the etiology of many epilepsies remains unknown. In 2017, the International League Against Epilepsy (ILAE) recognized an epilepsy resulting directly from an immune disorder with seizures as a core symptom. For an epilepsy to meet this classification, evidence of autoimmune-mediated central nervous system (CNS) inflammation is required. Currently, no strict diagnostic guidelines exist for autoimmune epilepsy. Autoimmune epilepsy is a general term for epilepsy mediated by or associated with antibodies sometimes linked to cancer. Antibodies to intracellular antigens have a high association with cancer (80%) such as ANNA-1 (Anti-Hu), PCA-1 (Anti-Yo), Anti-Ma1, and Anti-Ma2 (Ta). Such antibodies are often thought of as an epiphenomenon of T-cell-mediated neural tissue destruction because the antibodies are not directly causing the underlying neurologic disease. In contrast, antibodies to neural surface antigens are thought to directly cause neurologic disease, show a more robust response to immunotherapy, and have a more variable association with cancer. Typically, there is no history of epilepsy or seizure risk factors in the patient’s medical or family history. There can be a personal or family history of autoimmune disease that is organ or non-organ specific or cancer (particularly those strongly associated with autoimmune disease including SCLC, thymoma, teratoma, or lymphoma). Seizures of autoimmune epilepsy are most commonly focal temporal lobe seizures but seizure onset is often seen elsewhere. If there is a positive antibody result, cancer screening for the most common associated cancer type should be done. If antibody testing is negative, ovarian or testicular ultrasound and thoracic, abdominal/pelvic CT and full body PET scans are reasonable follow-up tests. Early diagnosis and treatment can drastically alter the course of the disease.

• #31 Autoimmune Epilepsy: New Development and Future Directions | IntechOpen

  https://www.intechopen.com/chapters/57010

  The action mechanism proposed for these factors is based on the release of pro-inflammatory substances inducing the danger signals expression and the consequent activation of auto-reactive T lymphocyte clones. […] Nevertheless, infections can also modify the clinical manifestations associated with autoimmune epilepsy (AE) in such a way that infections are involved in the induction and protection of AEs in genetically predisposed individuals. […] The target antigens that play a critical role in neuronal transmission and in plasticity include the N-methyl-D-aspartate (NMDA) receptor, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), the gamma-aminobutyric acid receptor (GABA), the glioma-inactivating leucine-rich protein (LGI1) and the contacting-associated protein 2 (CASPR2).

• #32 Discovery of the mechanisms behind epileptic seizures in autoimmune encephalitis | Paris Brain Institute

  https://parisbraininstitute.org/news/discovery-mechanisms-behind-epileptic-seizures-autoimmune-encephalitis

  Autoimmune encephalitis occurs as a result of an attack on the central nervous system by an individual’s own immune cells. It is an important cause to look for in adult and childhood epilepsy, once the classic seizure triggers have been excluded: an autoimmune cause is thought to be involved in up to 30% of cases. […] In autoimmune encephalitis, several proteins can be targeted by immune cells, such as NMDA receptors, leading to very severe neuropsychiatric disorders, or the synaptic protein LGI1, the most common target in patients with autoimmune epilepsy, which modulates the activity of the potassium channel KV1.1 at the synapse. […] The Paris Brain Institute team suggests a central role for potassium channels in epilepsy associated with antibody-related autoimmune encephalitis.

• #33 Autoimmune Epilepsy: New Development and Future Directions | IntechOpen

  https://www.intechopen.com/chapters/57010

  In NMDARAS, IgG antibodies are directed to the N-terminal extracellular domain of the GluN1 subunit of the NMDA receptor; the cultures of dissociated rat hippocampal neurons and antibody-containing cerebrospinal fluid (CSF) from patients with NMDARAS have been used to study the molecular mechanism by which IgG antibodies cause hypo function of the NMDAR. […] Encephalitis associated with antibodies against GABAB1 receptor is generally presented as limbic encephalitis, as well as drug-refractory seizures. […] The presence of autoantibodies against these receptors has been associated with seizures and changes in memory and behavior. […] Antibodies to the AMPAR have recently been described in patients with limbic encephalitis (LE). […] GAD antibodies act as a marker of the underlying autoimmune disease, although it is not known how antibodies against an intracellular enzyme can directly initiate pathological events; however, it is known that anti-GAD Abs inhibit the activity of GAD, and the synthesis of GABA antibodies to GAD is associated with several autoimmune disorders, including limbic encephalitis. […] Studies describing treatment of LGI1-antibody associated encephalopathy, LGI1 is a protein secreted by neurons that interact with pre- and postsynaptic receptors.

• #34

  https://www.jci.org/articles/view/125178

  The rapid expansion in the number of encephalitis disorders associated with autoantibodies against neuronal proteins has led to an incremental increase in use of the term autoimmune epilepsy, yet has occurred with limited attention to the physiopathology of each disease and genuine propensity to develop epilepsy. […] Indeed, most autoimmune encephalitides present with seizures, but the probability of evolving to epilepsy is relatively small. The risk of epilepsy is higher for disorders in which the antigens are intracellular (often T cell-mediated) compared with disorders in which the antigens are on the cell surface (antibody-mediated). […] The concept of autoimmune epilepsy was reinforced in the mid-1990s by the observation that rabbits immunized with the GluR3 subunit of the -amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) developed seizures, GluR3 antibodies, and pathological features resembling those of Rasmussens encephalitis.

• #35 Seizures, Epilepsy, and NORSE Secondary to Autoimmune Encephalitis: A Practical Guide for Clinicians

  https://www.mdpi.com/2227-9059/11/1/44

  The most recent International League Against Epilepsy (ILAE) classification has included “immune etiology” along with other well-known causes of epilepsy. […] Most autoimmune encephalitides (AE) present with seizures, but only a minority of cases evolve to long-term epilepsy. […] The risk of epilepsy is higher for patients harboring Abs targeting intracellular antigens (T cell-mediated and mostly paraneoplastic, such as Hu, CV2/CRMP5, Ma2, GAD65 Abs), compared with patients with neuronal surface Abs (antibody-mediated and less frequently paraneoplastic, such as NMDAR, GABAbR, LGI1, CASPR2 Abs). […] The Autoimmunity and Inflammation Taskforce proposed two main diagnostic entities: “acute symptomatic seizures secondary to AE” and “autoimmune-associated epilepsy”, the latter of which applied to a minority of cases, often due to the development of structural abnormalities after inflammation vanishes (e.g., mesial temporal sclerosis) or an enduring antigenic trigger (e.g., cancer in paraneoplastic cases).

• #36

  https://www.jci.org/articles/view/125178

  The rapid expansion in the number of encephalitis disorders associated with autoantibodies against neuronal proteins has led to an incremental increase in use of the term autoimmune epilepsy, yet has occurred with limited attention to the physiopathology of each disease and genuine propensity to develop epilepsy. […] Indeed, most autoimmune encephalitides present with seizures, but the probability of evolving to epilepsy is relatively small. The risk of epilepsy is higher for disorders in which the antigens are intracellular (often T cell-mediated) compared with disorders in which the antigens are on the cell surface (antibody-mediated). […] The concept of autoimmune epilepsy was reinforced in the mid-1990s by the observation that rabbits immunized with the GluR3 subunit of the -amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) developed seizures, GluR3 antibodies, and pathological features resembling those of Rasmussens encephalitis.

• #37 Seizures, Epilepsy, and NORSE Secondary to Autoimmune Encephalitis: A Practical Guide for Clinicians

  https://www.mdpi.com/2227-9059/11/1/44

  The most recent International League Against Epilepsy (ILAE) classification has included “immune etiology” along with other well-known causes of epilepsy. […] Most autoimmune encephalitides (AE) present with seizures, but only a minority of cases evolve to long-term epilepsy. […] The risk of epilepsy is higher for patients harboring Abs targeting intracellular antigens (T cell-mediated and mostly paraneoplastic, such as Hu, CV2/CRMP5, Ma2, GAD65 Abs), compared with patients with neuronal surface Abs (antibody-mediated and less frequently paraneoplastic, such as NMDAR, GABAbR, LGI1, CASPR2 Abs). […] The Autoimmunity and Inflammation Taskforce proposed two main diagnostic entities: “acute symptomatic seizures secondary to AE” and “autoimmune-associated epilepsy”, the latter of which applied to a minority of cases, often due to the development of structural abnormalities after inflammation vanishes (e.g., mesial temporal sclerosis) or an enduring antigenic trigger (e.g., cancer in paraneoplastic cases).

• #38

  https://www.jci.org/articles/view/125178

  Another important step in the field of autoimmune epilepsy was the identification of antibodies against glutamic acid decarboxylase 65 (GAD65; an enzyme involved in the synthesis of GABA) in patients with stiff-person syndrome. […] The group of antibody-mediated encephalitis disorders should be separated from other types of autoimmune encephalitis in which the antibodies target intracellular proteins, such as the above-mentioned paraneoplastic encephalitis, or GAD65 antibody-associated encephalitis. […] In summary, the predisposition to cause enduring seizures in autoimmune encephalitis is dependent on the mechanism that drives the immune response, ranging from a high predisposition in cytotoxic T cell-mediated encephalitis (intracellular antigens) to a moderate or absent predisposition in antibody-mediated encephalitis (surface antigens). […] A common feature of all types of autoimmune epileptic seizures is the refractoriness to antiepileptic drugs unless immunotherapy is concurrently used.

• #39 Unraveling Autoimmune Epilepsy

  https://www.neurologylive.com/view/unraveling-autoimmune-epilepsy

  This is because these antibodies may not be the cause of seizures, but more an epiphenomenona secondary symptom that occurs simultaneously with a condition but is not directly related to it. […] In a retrospective study of 50 patients, researchers showed that those who had antibodies to a neural surface antigen, the voltage gated potassium channel complex antigen, were more likely to become seizure-free compared with patients who had GAD-65 antibodies. […] To predict which patients are more likely to respond to immunotherapy, Dubey and his team have also introduced and validated the RITE (Response to Immunotherapy in Epilepsy) score. […] Patients with a RITE score greater than 7 are more likely to respond to immunotherapy. […] Most experts feel that a better understanding of the pathophysiology of autoimmune epilepsy is the way forward.

• #40 Autoimmune epilepsy | Nature Immunology

  https://www.nature.com/articles/ni0602-500

  An estimated 0.51% of the world population is epileptic, some with completely unknown etiology and no effective treatment. […] Epilepsies have long been viewed as diseases of the central nervous system (CNS), but in recent years, evidence has mounted that some may actually be autoimmune-mediated. […] The first clue to the autoimmune nature of some epilepsies came from the presence of antibodies to a major excitatory neurotransmitter in the CNS. […] Antibodies to this particular glutamate receptor, one of the AMPA (-3-hydroxy-5-methyl-4-isoxazolepropionic acid) subtypes (GluR3), have now been found in three severe human epilepsies: Rasmussen’s encephalitis (RE), noninflammatory focal epilepsy and catastrophic epilepsy. […] Specific cleavage of GluR3 by granzyme B, a serine protease released by activated immune cells, generates the GluR3B autoantigenic peptide, but only when an internal NH2-linked glycosylation sequence within the GluR3 recognition-sequence is not glycosylated. […] Interestingly, CD3+CD8+ cytotoxic T cells that contain granzyme B can be found in close association with neurons in the brains of RE patients and could contribute to neuronal death.

• #41 Autoimmune encephalitis and epilepsy: evolving definition and clinical spectrum

  https://www.e-cep.org/journal/view.php?number=20125553565

  An autoimmune response to the NR1 subunit of NMDAR has been shown in children to be triggered by various infectious agents, and different reports have suggested that anti-NMDAR encephalitis may be associated with HSV, Mycoplasma pneumoniae, measles virus, mumps, influenza A/H1N1 infection, group A hemolytic Streptococcus, and Toxoplasma gondii infection. […] The presence of autoantibodies directed against the synaptic protein LGI1 and adhesion molecule Caspr2 has not been found in children with acute encephalitis; thus, the role of these autoantibodies in the pediatric population is still debated. […] Patients with anti-GABAA R encephalitis develop rapidly progressive encephalitis with refractory seizures, SE, and/or epilepsia partialis continua. […] The response to immunosuppressive therapies was good in tumor-free patients.

• #42 Autoimmune Epilepsy: New Development and Future Directions | IntechOpen

  https://www.intechopen.com/chapters/57010

  The action mechanism proposed for these factors is based on the release of pro-inflammatory substances inducing the danger signals expression and the consequent activation of auto-reactive T lymphocyte clones. […] Nevertheless, infections can also modify the clinical manifestations associated with autoimmune epilepsy (AE) in such a way that infections are involved in the induction and protection of AEs in genetically predisposed individuals. […] The target antigens that play a critical role in neuronal transmission and in plasticity include the N-methyl-D-aspartate (NMDA) receptor, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), the gamma-aminobutyric acid receptor (GABA), the glioma-inactivating leucine-rich protein (LGI1) and the contacting-associated protein 2 (CASPR2).

• #43 What causes seizures in adults with no history?

  https://www.moleculera.com/seizures-adults-with-no-history/

  Autoimmune factors may play a role in the onset of seizures in adults with no history and who do not respond to standard medication. […] Identifying whether an autoimmune condition is causing the seizures or drug resistant epilepsy is important since treatment with immunotherapies can dramatically impact chances of recovery. […] A growing number of autoantibodies are being identified and linked with seizures that have no known cause. […] Specific autoimmune causes, typically associated with autoantibodies, have been increasingly identified in a subset of previously idiopathic seizure disorders. […] In some cases, autoimmune seizures may be the result of an infection-triggered autoimmune encephalopathy/encephalitis. […] Certain infections are known to trigger encephalitis (brain inflammation) and epilepsy in children, states Korff and Dale. […] Some of them directly infect the brain and cause a primary viral encephalitis; on the other hand, certain micro-organisms can induce a secondary autoimmune encephalitis.

• #44 Autoimmune encephalitis and epilepsy: evolving definition and clinical spectrum

  https://www.e-cep.org/journal/view.php?number=20125553565

  An autoimmune response to the NR1 subunit of NMDAR has been shown in children to be triggered by various infectious agents, and different reports have suggested that anti-NMDAR encephalitis may be associated with HSV, Mycoplasma pneumoniae, measles virus, mumps, influenza A/H1N1 infection, group A hemolytic Streptococcus, and Toxoplasma gondii infection. […] The presence of autoantibodies directed against the synaptic protein LGI1 and adhesion molecule Caspr2 has not been found in children with acute encephalitis; thus, the role of these autoantibodies in the pediatric population is still debated. […] Patients with anti-GABAA R encephalitis develop rapidly progressive encephalitis with refractory seizures, SE, and/or epilepsia partialis continua. […] The response to immunosuppressive therapies was good in tumor-free patients.

• #45 Autoimmune Epilepsy: New Development and Future Directions | IntechOpen

  https://www.intechopen.com/chapters/57010

  In epilepsy, there are no studies associating autoimmunity with genetic factors; however, studies have focused on other autoimmune diseases and focuses are mainly associated with major histocompatibility system. […] The HLA system has two fundamental properties that make it difficult to understand, the genes involved in the predisposition to AEs: polymorphism and linkage disequilibrium (LD). […] Genetic study with a cohort of 24 cases of Rasmussen (RE) autoimmune encephalitis, the human leukocyte antigen (HLA) class I and class II genes were sequenced; they got the association of three C*07 alleles: 02:01:01, DQA1*04:01:01, and DQB1*04:02:01, that increased the relative risk of RE. […] The same way, anti-leucine-rich glioma-inactivated (LGI1) encephalitis was associated with the DRB1*07:01-DQB1*02:02 haplotype in HLA class II genes, as well as with B*44:03 and C*07:06 in the HLA class I region.

• #46 Autoimmune Epilepsy: New Development and Future Directions | IntechOpen

  https://www.intechopen.com/chapters/57010

  In epilepsy, there are no studies associating autoimmunity with genetic factors; however, studies have focused on other autoimmune diseases and focuses are mainly associated with major histocompatibility system. […] The HLA system has two fundamental properties that make it difficult to understand, the genes involved in the predisposition to AEs: polymorphism and linkage disequilibrium (LD). […] Genetic study with a cohort of 24 cases of Rasmussen (RE) autoimmune encephalitis, the human leukocyte antigen (HLA) class I and class II genes were sequenced; they got the association of three C*07 alleles: 02:01:01, DQA1*04:01:01, and DQB1*04:02:01, that increased the relative risk of RE. […] The same way, anti-leucine-rich glioma-inactivated (LGI1) encephalitis was associated with the DRB1*07:01-DQB1*02:02 haplotype in HLA class II genes, as well as with B*44:03 and C*07:06 in the HLA class I region.

• #47 Autoimmune Epilepsy: New Development and Future Directions | IntechOpen

  https://www.intechopen.com/chapters/57010

  In epilepsy, there are no studies associating autoimmunity with genetic factors; however, studies have focused on other autoimmune diseases and focuses are mainly associated with major histocompatibility system. […] The HLA system has two fundamental properties that make it difficult to understand, the genes involved in the predisposition to AEs: polymorphism and linkage disequilibrium (LD). […] Genetic study with a cohort of 24 cases of Rasmussen (RE) autoimmune encephalitis, the human leukocyte antigen (HLA) class I and class II genes were sequenced; they got the association of three C*07 alleles: 02:01:01, DQA1*04:01:01, and DQB1*04:02:01, that increased the relative risk of RE. […] The same way, anti-leucine-rich glioma-inactivated (LGI1) encephalitis was associated with the DRB1*07:01-DQB1*02:02 haplotype in HLA class II genes, as well as with B*44:03 and C*07:06 in the HLA class I region.

• #48 Autoimmune Epilepsy

  https://practicalneurology.com/articles/2018-oct/autoimmune-epilepsy

  A newly recognized category of epilepsy caused by or associated with antibodies. Approximately 30% of patients with epilepsy do not achieve seizure freedom despite medical therapy, and the etiology of many epilepsies remains unknown. In 2017, the International League Against Epilepsy (ILAE) recognized an epilepsy resulting directly from an immune disorder with seizures as a core symptom. For an epilepsy to meet this classification, evidence of autoimmune-mediated central nervous system (CNS) inflammation is required. Currently, no strict diagnostic guidelines exist for autoimmune epilepsy. Autoimmune epilepsy is a general term for epilepsy mediated by or associated with antibodies sometimes linked to cancer. Antibodies to intracellular antigens have a high association with cancer (80%) such as ANNA-1 (Anti-Hu), PCA-1 (Anti-Yo), Anti-Ma1, and Anti-Ma2 (Ta). Such antibodies are often thought of as an epiphenomenon of T-cell-mediated neural tissue destruction because the antibodies are not directly causing the underlying neurologic disease. In contrast, antibodies to neural surface antigens are thought to directly cause neurologic disease, show a more robust response to immunotherapy, and have a more variable association with cancer. Typically, there is no history of epilepsy or seizure risk factors in the patient’s medical or family history. There can be a personal or family history of autoimmune disease that is organ or non-organ specific or cancer (particularly those strongly associated with autoimmune disease including SCLC, thymoma, teratoma, or lymphoma). Seizures of autoimmune epilepsy are most commonly focal temporal lobe seizures but seizure onset is often seen elsewhere. If there is a positive antibody result, cancer screening for the most common associated cancer type should be done. If antibody testing is negative, ovarian or testicular ultrasound and thoracic, abdominal/pelvic CT and full body PET scans are reasonable follow-up tests. Early diagnosis and treatment can drastically alter the course of the disease.

• #49 A New Epilepsy Etiology

  https://www.medscape.com/viewarticle/777407

  Autoimmune epilepsy is a newly recognized treatable cause of uncontrolled seizures. A retrospective review of patients who presented with uncontrolled seizures to both the epilepsy and neuroimmunology clinics of the Mayo Clinic between 2005 and 2010 identified 32 patients (19 females, 13 males with probable autoimmune epilepsy. […] A history of autoimmune disease was present in 50% of the patients and a family history of autoimmune disease was present in 53%. […] Neural autoantibodies were present in 29 (91%) of patients. […] Immunotherapy included IV methylprednisolone (n = 12), IVIg (n = 3), and combinations of IV methylprednisolone, IVIg, cyclophosphamide, or plasmapheresis (n = 12).

• #50 Autoimmune epilepsy: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/autoimmune-epilepsy

  Autoimmune epilepsy is a rare type of epilepsy that occurs as a result of an immune system imbalance. It develops due to immune antibodies targeting the brain. […] One potential cause of epilepsy is the immune systems activity damaging the brain. However, this is rare. […] A 2020 study defined that autoimmune epilepsy refers to different diseases, but they all cause chronic seizures and the ongoing presence of antibodies that target brain proteins. […] The condition develops when certain antibodies target specific receptors in the brain. It is not clear whether these antibodies have any beneficial function or exactly why they develop. […] Sometimes, these antibodies relate to a tumor, in which case a doctor refers to them as paraneoplastic. […] Systemic autoimmune disorders (SADs) affect the whole body rather than just the brain. However, people with these types of conditions especially lupus and rheumatoid arthritis might have a higher risk of epilepsy, according to a 2021 review.

• #51 Epilepsy Associated with Systemic Autoimmune Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3639560/

  Systemic autoimmune disorders affect multiple organ systems. Brain involvement commonly causes seizures, which may be the presenting symptom. […] Mechanisms underlying CNS pathology in systemic autoimmune disorders and specifically factors predisposing these patients are discussed, including vascular disease (e.g., prothrombotic state, anticardiolipin antibody, emboli, vasculitis), antineuronal antibodies, immune complexes, cytokines, metabolic disorders, infection, and therapy. […] There are many causes of seizures in systemic autoimmune disorders, and the first clinical challenge is to determine not only the cause but also the significance of seizures. […] Seizures are associated with increased morbidity and mortality in adults and children. […] Antiphospholipid antibodies are prothrombotic and can cause vascular disease, which can secondarily cause seizures.

• #52 Autoimmune epilepsy: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/autoimmune-epilepsy

  Autoimmune epilepsy is a rare type of epilepsy that occurs as a result of an immune system imbalance. It develops due to immune antibodies targeting the brain. […] One potential cause of epilepsy is the immune systems activity damaging the brain. However, this is rare. […] A 2020 study defined that autoimmune epilepsy refers to different diseases, but they all cause chronic seizures and the ongoing presence of antibodies that target brain proteins. […] The condition develops when certain antibodies target specific receptors in the brain. It is not clear whether these antibodies have any beneficial function or exactly why they develop. […] Sometimes, these antibodies relate to a tumor, in which case a doctor refers to them as paraneoplastic. […] Systemic autoimmune disorders (SADs) affect the whole body rather than just the brain. However, people with these types of conditions especially lupus and rheumatoid arthritis might have a higher risk of epilepsy, according to a 2021 review.

• #53 What causes seizures in adults with no history?

  https://www.moleculera.com/seizures-adults-with-no-history/

  Autoimmune factors may play a bigger role in seizure disorders than previously suspected. […] But now, studies indicate that an autoimmune cause appears to be the potential culprit in at least 20% of [those] cases. […] Mounting evidence also indicates that an immune dysfunction or abnormal autoimmune activity can elicit a sudden onset of seizures in adults with no history of the illness. […] Its well-established that people with certain autoimmune disorders, such as lupus, type 1 diabetes, celiac disease, multiple sclerosis, rheumatoid arthritis, and psoriasis, are at greater risk of developing epileptic seizures. […] Investigators from Mayo Clinic point out, Its now a recognized and accepted fact that a proportion of patients with new-onset epilepsy can have an autoimmune etiology.

• #54 Epilepsy Associated with Systemic Autoimmune Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3639560/

  The question of cause and effect remains unanswered. […] Among SLE patients, CSF antineuronal antibodies are increased in 90% with psychosis, encephalopathy, or seizures as compared to 11% without CNS disease. […] Seizures occur more frequently in children than in adults with neurosarcoidosis. […] The prevalence of epilepsy in CD ranges from 1% to 5%. […] The etiology of seizures in CD is not entirely known, but gluten neurotoxicity, or pyridoxine or folate deficiency are suspected. […] In isolated patients with celiac disease and epilepsy refractory to AEDs, seizure control has been obtained with a gluten-free diet. […] Seizures and epilepsy occur in 2.2% to 5% of Middle Eastern and Asian cases of Behet’s disease. […] Seizures affect 66% of Hashimoto’s encephalopathy patients. […] The pathophysiology of HE and HE-associated seizures remains uncertain. […] Seizures often complicate systemic autoimmune disorders through a variety of mechanisms.

• #55 What causes seizures in adults with no history?

  https://www.moleculera.com/seizures-adults-with-no-history/

  Autoimmune factors may play a bigger role in seizure disorders than previously suspected. […] But now, studies indicate that an autoimmune cause appears to be the potential culprit in at least 20% of [those] cases. […] Mounting evidence also indicates that an immune dysfunction or abnormal autoimmune activity can elicit a sudden onset of seizures in adults with no history of the illness. […] Its well-established that people with certain autoimmune disorders, such as lupus, type 1 diabetes, celiac disease, multiple sclerosis, rheumatoid arthritis, and psoriasis, are at greater risk of developing epileptic seizures. […] Investigators from Mayo Clinic point out, Its now a recognized and accepted fact that a proportion of patients with new-onset epilepsy can have an autoimmune etiology.

• #56 Epilepsy Associated with Systemic Autoimmune Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3639560/

  The question of cause and effect remains unanswered. […] Among SLE patients, CSF antineuronal antibodies are increased in 90% with psychosis, encephalopathy, or seizures as compared to 11% without CNS disease. […] Seizures occur more frequently in children than in adults with neurosarcoidosis. […] The prevalence of epilepsy in CD ranges from 1% to 5%. […] The etiology of seizures in CD is not entirely known, but gluten neurotoxicity, or pyridoxine or folate deficiency are suspected. […] In isolated patients with celiac disease and epilepsy refractory to AEDs, seizure control has been obtained with a gluten-free diet. […] Seizures and epilepsy occur in 2.2% to 5% of Middle Eastern and Asian cases of Behet’s disease. […] Seizures affect 66% of Hashimoto’s encephalopathy patients. […] The pathophysiology of HE and HE-associated seizures remains uncertain. […] Seizures often complicate systemic autoimmune disorders through a variety of mechanisms.

• #57 Autoimmune Diseases That Cause Seizures: Understanding and Management | Maggie Yu MD, IFMCP

  https://drmaggieyu.com/blog/autoimmune-diseases-that-cause-seizures-understanding-and-management/

  Hashimoto’s encephalopathy often includes recurrent seizures as a symptom. This rare disease links thyroid autoimmunity with neurological symptoms such as confusion and memory loss, posing a risk for patients. […] The connection between type 1 diabetes and seizures underscores how systemic autoimmune disorders impact neurological health in patients beyond direct neurotoxic effects, increasing the risk of disease in the CSF. […] Autoimmune disease etiology suggests that when antibodies cross into the brain due to a compromised BBB in patients, they might bind with neuronal antigens incorrectly triggering epileptic activity. […] Immunosuppressive medications are often crucial in controlling seizures in patients with autoimmune diseases. However, assessing the risks versus benefits of long-term use for patients with the disease is essential. […] Immunosuppression can be effective since it targets the underlying immune dysfunction that contributes to seizure development.

• #58 What causes seizures in adults with no history?

  https://www.moleculera.com/seizures-adults-with-no-history/

  Autoimmune factors may play a bigger role in seizure disorders than previously suspected. […] But now, studies indicate that an autoimmune cause appears to be the potential culprit in at least 20% of [those] cases. […] Mounting evidence also indicates that an immune dysfunction or abnormal autoimmune activity can elicit a sudden onset of seizures in adults with no history of the illness. […] Its well-established that people with certain autoimmune disorders, such as lupus, type 1 diabetes, celiac disease, multiple sclerosis, rheumatoid arthritis, and psoriasis, are at greater risk of developing epileptic seizures. […] Investigators from Mayo Clinic point out, Its now a recognized and accepted fact that a proportion of patients with new-onset epilepsy can have an autoimmune etiology.

• #59 Autoimmune Diseases That Cause Seizures: Understanding and Management | Maggie Yu MD, IFMCP

  https://drmaggieyu.com/blog/autoimmune-diseases-that-cause-seizures-understanding-and-management/

  Hashimoto’s encephalopathy often includes recurrent seizures as a symptom. This rare disease links thyroid autoimmunity with neurological symptoms such as confusion and memory loss, posing a risk for patients. […] The connection between type 1 diabetes and seizures underscores how systemic autoimmune disorders impact neurological health in patients beyond direct neurotoxic effects, increasing the risk of disease in the CSF. […] Autoimmune disease etiology suggests that when antibodies cross into the brain due to a compromised BBB in patients, they might bind with neuronal antigens incorrectly triggering epileptic activity. […] Immunosuppressive medications are often crucial in controlling seizures in patients with autoimmune diseases. However, assessing the risks versus benefits of long-term use for patients with the disease is essential. […] Immunosuppression can be effective since it targets the underlying immune dysfunction that contributes to seizure development.

• #60 What causes seizures in adults with no history?

  https://www.moleculera.com/seizures-adults-with-no-history/

  Autoimmune factors may play a bigger role in seizure disorders than previously suspected. […] But now, studies indicate that an autoimmune cause appears to be the potential culprit in at least 20% of [those] cases. […] Mounting evidence also indicates that an immune dysfunction or abnormal autoimmune activity can elicit a sudden onset of seizures in adults with no history of the illness. […] Its well-established that people with certain autoimmune disorders, such as lupus, type 1 diabetes, celiac disease, multiple sclerosis, rheumatoid arthritis, and psoriasis, are at greater risk of developing epileptic seizures. […] Investigators from Mayo Clinic point out, Its now a recognized and accepted fact that a proportion of patients with new-onset epilepsy can have an autoimmune etiology.

• #61 Autoimmune Disease That Causes Seizures: Insights & Treatments | Maggie Yu MD, IFMCP

  https://drmaggieyu.com/blog/autoimmune-disease-that-causes-seizures/

  Early detection is key in managing autoimmune epilepsy effectively. […] Brain imaging is crucial in diagnosing autoimmune seizure disorders. […] Cerebrospinal fluid (CSF) analysis is another diagnostic method for detecting autoimmune markers linked to seizures in patients with the disease. […] Blood tests play their part in patients by identifying specific autoantibodies related to epilepsy, such as antibodies against glutamic acid decarboxylase, informing disease management and potential immunotherapy approaches. […] Multiple sclerosis (MS) is a neurological disorder that affects the brain and spinal cord, putting patients at risk. It often leads to physical and cognitive disabilities. MS can also cause seizure disorders in some individuals. […] A study shows that patients with lupus, an autoimmune condition, are at risk of causing widespread inflammation throughout the body, including vital organs.

• #62 Autoimmune epilepsy: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/autoimmune-epilepsy

  SADs cause inflammation, which can lead to damage to the brain that disrupts electrical signals, leading to epilepsy. […] The effectiveness of treatment depends on the type of autoimmune epilepsy. For example, people with cancer-related autoimmune epilepsy may have a lower outlook than those with anti-NMDA receptor encephalitis. […] Autoimmune epilepsy is a rare type of epilepsy that occurs due to the immune system attacking specific proteins in the brain, leading to seizures. The types include autoimmune limbic encephalitis, FIRES, and epilepsy induced by systemic autoimmune disorders. […] To treat autoimmune epilepsy, doctors use steroid medications and immunotherapy to address the underlying autoimmune response.

• #63 Epilepsy Associated with Systemic Autoimmune Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3639560/

  Systemic autoimmune disorders affect multiple organ systems. Brain involvement commonly causes seizures, which may be the presenting symptom. […] Mechanisms underlying CNS pathology in systemic autoimmune disorders and specifically factors predisposing these patients are discussed, including vascular disease (e.g., prothrombotic state, anticardiolipin antibody, emboli, vasculitis), antineuronal antibodies, immune complexes, cytokines, metabolic disorders, infection, and therapy. […] There are many causes of seizures in systemic autoimmune disorders, and the first clinical challenge is to determine not only the cause but also the significance of seizures. […] Seizures are associated with increased morbidity and mortality in adults and children. […] Antiphospholipid antibodies are prothrombotic and can cause vascular disease, which can secondarily cause seizures.

• #64 Clinical Approach to Autoimmune Epilepsy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7541993/

  Autoimmune epilepsy is a newly emerging area of epilepsy. The concept of autoimmune as an etiology has recently been revisited thanks to advances in autoimmune encephalitis and precision medicine with immunotherapies. […] Autoimmune epilepsy is a group of epilepsies mediated by all kinds of autoimmune reactions. Most cases of autoimmune epilepsy consist of autoimmune limbic encephalitis, with inflammation of the limbic area causing seizure, memory loss, unconsciousness, and psychiatric symptoms. […] Autoimmune epilepsy can be associated with a tumor as a paraneoplastic syndrome, but association with an incidental tumor is also common. […] A multicenter study found the NORSE etiology in about half of the patients (47%), with autoimmune etiologies (37%, comprising 19% nonparaneoplastic and 18% paraneoplastic) being more common than infection (8%). These results indicate that an autoimmune pathogenesis is much more likely than a viral infection in NORSE.

• #65 :: JCN :: Journal of Clinical Neurology

  https://thejcn.com/DOIx.php?id=10.3988/jcn.2020.16.4.519

  Autoimmune epilepsy is a newly emerging area of epilepsy. The concept of autoimmune as an etiology has recently been revisited thanks to advances in autoimmune encephalitis and precision medicine with immunotherapies. […] Autoimmune epilepsy is a group of epilepsies mediated by all kinds of autoimmune reactions. Most cases of autoimmune epilepsy consist of autoimmune limbic encephalitis, with inflammation of the limbic area causing seizure, memory loss, unconsciousness, and psychiatric symptoms. […] Autoimmune epilepsy can be associated with a tumor as a paraneoplastic syndrome, but association with an incidental tumor is also common. […] A multicenter study found the NORSE etiology in about half of the patients (47%), with autoimmune etiologies (37%, comprising 19% nonparaneoplastic and 18% paraneoplastic) being more common than infection (8%). These results indicate that an autoimmune pathogenesis is much more likely than a viral infection in NORSE. Therefore, after performing a thorough evaluation of infection, it is possible to consider NORSE as potentially autoimmune epilepsy requiring active immunotherapy.

• #66

  https://journals.lww.com/nsan/fulltext/2023/40030/autoimmune_mechanisms_in_focal_epilepsy_of_unknown.1.aspx

  The significance of anti-neuronal antibodies identified in sera of FEUC patients is still not clearly evident. […] Regardless of whether autoimmune mechanisms antecede or precede initiation of seizures, antibody-mediated animal model studies suggest that anti-neural antibodies show a reinforcing action on seizure severity and frequency. […] Clinical conditions that have been recognized as closely associated with autoimmune etiology are postencephalitis epilepsy (sequelae of autoimmune encephalitis), Rasmussen encephalitis, and GAD-antibody positive TLE. […] Autoimmune epilepsy may occur in the setting of autoimmune encephalitis as postencephalitic sequelae, FEUC patients including those with GAD antibodies and Rasmussen encephalitis, whereas syndromes of FIRES and NORSE are recently introduced candidates to be included in this group of disorders.

• #67

  https://journals.lww.com/nsan/fulltext/2023/40030/autoimmune_mechanisms_in_focal_epilepsy_of_unknown.1.aspx

  The significance of anti-neuronal antibodies identified in sera of FEUC patients is still not clearly evident. […] Regardless of whether autoimmune mechanisms antecede or precede initiation of seizures, antibody-mediated animal model studies suggest that anti-neural antibodies show a reinforcing action on seizure severity and frequency. […] Clinical conditions that have been recognized as closely associated with autoimmune etiology are postencephalitis epilepsy (sequelae of autoimmune encephalitis), Rasmussen encephalitis, and GAD-antibody positive TLE. […] Autoimmune epilepsy may occur in the setting of autoimmune encephalitis as postencephalitic sequelae, FEUC patients including those with GAD antibodies and Rasmussen encephalitis, whereas syndromes of FIRES and NORSE are recently introduced candidates to be included in this group of disorders.

• #68 Seizures, Epilepsy, and NORSE Secondary to Autoimmune Encephalitis: A Practical Guide for Clinicians

  https://www.mdpi.com/2227-9059/11/1/44

  The most recent International League Against Epilepsy (ILAE) classification has included “immune etiology” along with other well-known causes of epilepsy. […] Most autoimmune encephalitides (AE) present with seizures, but only a minority of cases evolve to long-term epilepsy. […] The risk of epilepsy is higher for patients harboring Abs targeting intracellular antigens (T cell-mediated and mostly paraneoplastic, such as Hu, CV2/CRMP5, Ma2, GAD65 Abs), compared with patients with neuronal surface Abs (antibody-mediated and less frequently paraneoplastic, such as NMDAR, GABAbR, LGI1, CASPR2 Abs). […] The Autoimmunity and Inflammation Taskforce proposed two main diagnostic entities: “acute symptomatic seizures secondary to AE” and “autoimmune-associated epilepsy”, the latter of which applied to a minority of cases, often due to the development of structural abnormalities after inflammation vanishes (e.g., mesial temporal sclerosis) or an enduring antigenic trigger (e.g., cancer in paraneoplastic cases).

• #69 Seizures, Epilepsy, and NORSE Secondary to Autoimmune Encephalitis: A Practical Guide for Clinicians

  https://www.mdpi.com/2227-9059/11/1/44

  Before making a diagnosis of AE as the cause of seizures and epilepsy, several more common alternative diagnoses need to be ruled out, including structural, genetic, infectious, and metabolic etiologies. […] The most frequent neuronal surface Abs associated with seizures and epilepsy are shown in Table 1. […] The most common Abs against intracellular antigens associated with epileptic manifestations are shown in Table 2. […] Most patients with acute symptomatic seizures secondary to AE do not develop autoimmune-associated epilepsy, justifying gradual ASMs tapering after the acute phase in most seizure-free patients lacking epileptic discharges on EEG examinations. […] A minority of them will evolve to an autoimmune-associated epilepsy, especially those with onconeural (paraneoplastic) Abs, as well as those with GAD65 Abs.

• #70

  https://journals.lww.com/nsan/fulltext/2023/40030/autoimmune_mechanisms_in_focal_epilepsy_of_unknown.1.aspx

  The significance of anti-neuronal antibodies identified in sera of FEUC patients is still not clearly evident. […] Regardless of whether autoimmune mechanisms antecede or precede initiation of seizures, antibody-mediated animal model studies suggest that anti-neural antibodies show a reinforcing action on seizure severity and frequency. […] Clinical conditions that have been recognized as closely associated with autoimmune etiology are postencephalitis epilepsy (sequelae of autoimmune encephalitis), Rasmussen encephalitis, and GAD-antibody positive TLE. […] Autoimmune epilepsy may occur in the setting of autoimmune encephalitis as postencephalitic sequelae, FEUC patients including those with GAD antibodies and Rasmussen encephalitis, whereas syndromes of FIRES and NORSE are recently introduced candidates to be included in this group of disorders.

• #71 Autoimmune Epilepsy: New Development and Future Directions | IntechOpen

  https://www.intechopen.com/chapters/57010

  In NMDARAS, IgG antibodies are directed to the N-terminal extracellular domain of the GluN1 subunit of the NMDA receptor; the cultures of dissociated rat hippocampal neurons and antibody-containing cerebrospinal fluid (CSF) from patients with NMDARAS have been used to study the molecular mechanism by which IgG antibodies cause hypo function of the NMDAR. […] Encephalitis associated with antibodies against GABAB1 receptor is generally presented as limbic encephalitis, as well as drug-refractory seizures. […] The presence of autoantibodies against these receptors has been associated with seizures and changes in memory and behavior. […] Antibodies to the AMPAR have recently been described in patients with limbic encephalitis (LE). […] GAD antibodies act as a marker of the underlying autoimmune disease, although it is not known how antibodies against an intracellular enzyme can directly initiate pathological events; however, it is known that anti-GAD Abs inhibit the activity of GAD, and the synthesis of GABA antibodies to GAD is associated with several autoimmune disorders, including limbic encephalitis. […] Studies describing treatment of LGI1-antibody associated encephalopathy, LGI1 is a protein secreted by neurons that interact with pre- and postsynaptic receptors.

• #72 Unraveling Autoimmune Epilepsy

  https://www.neurologylive.com/view/unraveling-autoimmune-epilepsy

  Antiepileptic drugs may still be effective in a few cases, but they treat the symptom of the autoimmune condition, and not the cause, Higdon said. […] Once the cause is known, it makes sense to treat autoimmune epilepsy just like other autoimmune diseases by modulating the immune system. […] Along with antiepileptic drugs, we use either steroids, intravenous immunoglobulin (IVIG), or plasma exchange, Higdon said. […] Indeed, one study showed that immunomodulatory therapy led to a 19-fold increase in odds of a better seizure outcome, with plasmapheresis (odds ratio [OR], 32.5) proving to be more effective than intravenous steroids (OR, 8.25). […] Higdon clarified that the kind of antibody present could influence response to immunotherapy. While antibodies to neural surface antigens (such as LGI1 and CASPR2) may respond well to immunotherapy, antibodies to intracellular antigens (like GAD-65) are less responsive, she said.

• #73 Unraveling Autoimmune Epilepsy

  https://www.neurologylive.com/view/unraveling-autoimmune-epilepsy

  This is because these antibodies may not be the cause of seizures, but more an epiphenomenona secondary symptom that occurs simultaneously with a condition but is not directly related to it. […] In a retrospective study of 50 patients, researchers showed that those who had antibodies to a neural surface antigen, the voltage gated potassium channel complex antigen, were more likely to become seizure-free compared with patients who had GAD-65 antibodies. […] To predict which patients are more likely to respond to immunotherapy, Dubey and his team have also introduced and validated the RITE (Response to Immunotherapy in Epilepsy) score. […] Patients with a RITE score greater than 7 are more likely to respond to immunotherapy. […] Most experts feel that a better understanding of the pathophysiology of autoimmune epilepsy is the way forward.

• #74

  https://link.springer.com/article/10.1007/s13311-019-00750-3

  In some instances, the immunological trigger is an underlying occult tumor. […] Infection is another potential trigger for autoimmune neurological syndrome. […] Patients with autoimmune epilepsy usually present with new onset of refractory seizures with one or more coexisting features of autoimmune encephalitis including subacute progressive cognitive decline, psychiatric symptoms, viral prodrome, autonomic dysfunction, inflammatory CSF, oncological association, or brain MRI changes consistent with autoimmune encephalitis. […] Using APE2 score, neural specific antibody serum status, and trial of immunotherapy, a diagnostic criterion for autoimmune epilepsy has been proposed. […] Treatment of patients with autoimmune epilepsy is comprised of immunotherapy, removal of an immunologic trigger such as a tumor (when applicable), and symptomatic therapy including antiseizure medications. […] Most patients with autoimmune epilepsy and encephalitis are responsive to either first- or second-line therapies. However, a subset of patients remains refractory to multiple immunotherapies.

• #75 Identification and Treatment of Autoimmune Epilepsy – Contemporary Advances in Epilepsy

  https://www.medpagetoday.com/resource-centers/contemporary-advances-epilepsy/identification-and-treatment-autoimmune-epilepsy/2088

  Good seizure outcomes were strongly tied to the use of immunomodulatory therapy, particularly intravenous methylprednisolone or plasmapheresis. […] There are many examples in the literature where patients with autoimmune epilepsy preferentially respond to immunotherapy. […] The concept that some of these patients that have medically intractable epilepsy actually have a treatable and potentially reversible condition is very important. […] If you diagnose autoimmune epilepsy in these patients early and treat them, you can actually cure them.

Zobacz więcej