Abstract
OBJECTIVE: To investigate risk factors of neuronal surface antibodies (NSAbs) and develop a nomogram that could identify patients at the odds of NSAbs among the elderly (aged 60 years or older) with new-onset seizures of unknown etiology. METHODS: Clinical data for aged ≥60 years diagnosed with new-onset seizures of unknown etiology were retrospectively reviewed. A nomogram based on multivariable logistic regression was constructed. Model performance of nomogram was evaluated using area under the curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC). Meanwhile, it was internally validated by bootstrap validation in current cohort. RESULTS: Of 147 patients included in final analysis, 68 (46.3%) had NSAbs-mediated encephalitis. Six factors were identified: duration of seizures less than 3 months (OR:14.259; 95% CI: 4.480-45.386), focal-onset seizures (OR:12.457; 95% CI: 2.710-57.261), psychiatric deficits (OR:10.063; 95% CI: 3.231-31.343), sleep disorders (OR:3.091; 95% CI: 1.011-9.454), hyponatremia (OR:6.252; 95% CI: 1.445-27.043), and medial temporal lobe (MTL) lesions on MRI (OR:4.102; 95% CI: 1.382-12.169). The nomogram had a good discrimination with an AUC of 0.916 and with a corrected AUC of 0.881 after the bootstrapping validation, our model also exhibited a better predictive performance than scoring systems commonly used clinically. Additionally, the calibration curve showed that predicted NSAbs-positive rates of nomogram were closely aligned with actual observed results. Moreover, the nomogram achieved well on clinical utility by using the DCA and CIC. INTERPRETATION: Our nomogram may provide a convenient and useful tool for identifying the elderly with new-onset seizures of unknown etiology who are at risk of NSAbs-mediated encephalitis, which would allow these patients receive earlier immunotherapy.