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Electroclinical insights into autoimmune epilepsy.

Lisa Gillinder1, Jason Papacostas1, Sasha Dionisio1

  • 1Mater Advanced Epilepsy Unit, Mater Hospital, Brisbane, Australia.

Journal of Neuroimmunology
|February 25, 2019
PubMed
Summary

This case study shows a patient with refractory perisylvian epilepsy who became seizure-free with immunotherapy. It highlights the need to consider autoimmune epilepsy, even with negative antibody tests.

Keywords:
AutoimmuneEpilepsyStereo electroencephalography

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Area of Science:

  • Neurology
  • Immunology
  • Epileptology

Background:

  • Chronic autoimmune epilepsy is an emerging diagnosis with unclear clinical and electrographic characteristics.
  • Refractory perisylvian epilepsy poses diagnostic challenges, particularly when antibody-negative.

Observation:

  • A patient with antibody-negative refractory perisylvian epilepsy underwent diagnostic Stereo-electroencephalography (SEEG).
  • SEEG revealed multifocal epilepsy involving the perisylvian-temporal networks, with significant posterior insula involvement and independent seizure generation from five locations.
  • Continuous interictal spiking was observed across multiple foci in the right hemisphere.

Findings:

  • Immunomodulatory treatment with intravenous methylprednisolone and immunoglobulin during SEEG led to the cessation of spiking and seizures.
  • The patient achieved sustained seizure freedom off anti-seizure medications, remaining seizure-free on immunotherapy.

Implications:

  • This case underscores the importance of including autoimmune epilepsy in the differential diagnosis for refractory epilepsy, especially perisylvian types.
  • It suggests the existence of autoimmune epilepsy phenotypes not detected by current antibody tests, necessitating further research into clinical and electrographic correlations.
  • The findings offer insights into a potential electroclinical syndrome associated with autoimmune epilepsy.