Efficacy of antiepileptic drugs in autoimmune epilepsy: A systematic review

Review the evidence of the efficacy of AEDs (antiepileptic drugs) in autoimmune epilepsy.

Literature research on Medline and Embase was carried out through January 2018. We included MeSH terms, free text and terms related to "autoimmune epilepsy", "autoimmune encephalitis", "limbic encephalitis", "autoimmune seizures", "antiepileptic drug", "seizure treatment", and "epilepsy treatment". The research was carried out by two reviewers who independently examined titles, abstracts and selection criteria. The main outcome was AED efficacy. Results regarding types of AEDs and autoantibody presence and type in responding patients were considered secondary endpoints. Quality of evidence was analysed by reading the whole text and following Scottish Intercollegiate Guidelines Network (SIGN) guidelines.

After an initial selection of 1656 articles, only six retrospective observational studies with a level of evidence between 2+ and 3 and a SIGN B recommendation degree remained. The total number of patients examined was 139. The estimated efficacy of AEDs with AE was 10.7%. There was response to AEDs in 18% of seronegative patients, 11% in VGKC positives and in 8% with GAD65. Seventy-three percent of responders to AEDs were in treatment with Na+ channel blockers in monotherapy or in combination.

The efficacy of AEDs in AE was low, although this may be in part due to a selection bias. Nevertheless, patients could benefit from these drugs even after immunotherapy failure. Seronegative patients seemed to have a better response to AEDs.