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A Simple Cell-based Immunofluorescence Assay to Detect Autoantibody Against the N-Methyl-D-Aspartate NMDA Receptor in Blood
Published on: January 9, 2018
Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABABR Antibodies:
Anna Rada1, Anne Hagemann1, Charlotte Aaberg Poulsen1
1From the Department of Epileptology (Krankenhaus Mara) (A.R., C.G.B., U.S.), Medical School, Bielefeld University, Campus Bielefeld-Bethel; Society for Epilepsy Research (A.H.), Bielefeld, Germany; Department of Neurology (C.A.P., M.B.), Odense University Hospital; Department of Clinical Research (M.B.), University of Southern Denmark, Odense, Denmark; Department of Epileptology (T. Baumgartner, R.S.), University Hospital Bonn, Germany; Department of Immunology and Biotechnology (T. Berki), University of Pécs, Medical School, Hungary; Department of Neurology (J.B., Y.C., M.J.T., J.M.V.), Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands; Division of Epilepsy (J.W.B., K.M.S.), Department of Neurology, Mayo Clinic, Rochester, MN; NYU Comprehensive Epilepsy Center (A.C., C. Steriade), New York; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., A.F., J. Honnorat, S.M.-C.), Hospices Civils de Lyon, Hôpital Neurologique, UMR MELIS Inserm 1314 / CNRS 5284, Université Claude Bernard Lyon1, France; Department of Neurology (M.E., P.M.), Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic; Department of Neurology (A.R.F., J. Hébert), Columbia University Irving Medical Center (CUIMC)/New York Presbyterian Hospital, New York; Department of Neurology (Z. Hayden), Medical School, University of Pécs, Pécs, Hungary; Division of Neurology (J. Hébert), University of Toronto, Ontario, Canada; Epilepsy-Center Berlin-Brandenburg (M.H., M.I.-F.), Department of Neurology, Charité - Universitätsmedizin Berlin, Germany; Department of Neurology (Z. Hong), West China Hospital, Sichuan University, Chengdu, China; Oxford Autoimmune Neurology Group (S.R.I., S.R., C.E.U.), Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom; Department of Neurology and Neurosciences (S.R.I.), Mayo Clinic, Jacksonville, FL; Department of Neurology with Institute of Translational Neurology (S.K., C. Strippel), University Hospital Münster, Germany; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Faculty of Medicine and Health, University of Sydney; Department of Neurology, Concord Hospital, Sydney, Australia; Division of Neurology (C.E.U.), Department of Medicine, University of British Columbia, Vancouver, Canada; and Laboratory Krone (C.G.B.), Bad Salzuflen, Germany.
Background And Objectives:
Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABABR). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries.
Methods:
This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABABR-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models.
Results:
We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABABR-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85-0.92) for NMDAR, 0.84 (CI 0.80-0.88) for LGI1, 0.82 (CI 0.75-0.90) for CASPR2, and 0.76 (CI 0.62-0.93) for GABABR.
Discussion:
Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.
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