Prevalence of neurologic autoantibodies in cohorts of patients with new and established epilepsy

  • Tanja Brenner
    Nuffield Department of Clinical Neurosciences John Radcliffe Hospital Oxford United Kingdom
  • Graeme J. Sills
    Department of Molecular and Clinical Pharmacology University of Liverpool Liverpool United Kingdom
  • Yvonne Hart
    Nuffield Department of Clinical Neurosciences John Radcliffe Hospital Oxford United Kingdom
  • Stephen Howell
    Department of Neurology Royal Hallamshire Hospital Sheffield United Kingdom
  • Patrick Waters
    Nuffield Department of Clinical Neurosciences John Radcliffe Hospital Oxford United Kingdom
  • Martin J. Brodie
    Epilepsy Unit Western Infirmary Glasgow United Kingdom
  • Angela Vincent
    Nuffield Department of Clinical Neurosciences John Radcliffe Hospital Oxford United Kingdom
  • Bethan Lang
    Nuffield Department of Clinical Neurosciences John Radcliffe Hospital Oxford United Kingdom

Description

<jats:title>Summary</jats:title><jats:sec><jats:title>Purpose</jats:title><jats:p>Autoantibodies to specific neurologic proteins are associated with subacute onset encephalopathies, which often present with seizures that are poorly controlled by conventional antiepileptic drugs (AEDs). Previous cross‐sectional studies have found specific neurologic antibodies in a small proportion of people with established epilepsy, but these investigations have seldom included patients with recent diagnosis.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We screened two large epilepsy cohorts to investigate the prevalence of multiple autoantibodies in adult patients with either established or newly diagnosed, untreated epilepsy.</jats:p></jats:sec><jats:sec><jats:title>Key Findings</jats:title><jats:p>Eleven percent of patients had antibodies to one or more antigen: voltage‐gated potassium channel (<jats:styled-content style="fixed-case">VGKC</jats:styled-content>) complex proteins (5%), glycine receptors (3%), and glutamic acid decarboxylase (<jats:styled-content style="fixed-case">GAD</jats:styled-content>) and <jats:italic>N</jats:italic>‐methyl‐<jats:sc>d</jats:sc>‐aspartate (<jats:styled-content style="fixed-case">NMDA</jats:styled-content>) receptors (1.7% each). There was no difference in the prevalence of antibodies, individually or collectively, between patients with established and newly diagnosed epilepsy or with generalized or focal epilepsy. There was, however, a significantly higher prevalence of positive antibody titers in patients with focal epilepsy of unknown cause than in those with structural/metabolic focal epilepsy (14.8% vs. 6.3%; p < 0.02). Newly diagnosed antibody‐positive patients were less likely to achieve adequate seizure control with initial treatment than antibody‐negative patients, but this difference failed to reach statistical significance.</jats:p></jats:sec><jats:sec><jats:title>Significance</jats:title><jats:p>The presence of autoantibodies is equally common in newly diagnosed and established epilepsy, it is therefore unlikely to be an epiphenomenon of long‐standing refractory seizures.</jats:p></jats:sec>

Journal

  • Epilepsia

    Epilepsia 54 (6), 1028-1035, 2013-03-06

    Wiley

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