Effect of Immunotherapy on Seizure Outcome in Patients with Autoimmune Encephalitis: A Prospective Observational Registry Study

免疫治疗对自身免疫性脑炎患者癫痫发作结果的影响:一项前瞻性观察性注册研究

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作者:Jung-Ick Byun, Soon-Tae Lee, Keun-Hwa Jung, Jun-Sang Sunwoo, Jangsup Moon, Jung-Ah Lim, Doo Young Lee, Yong-Won Shin, Tae-Joon Kim, Keon-Joo Lee, Woo-Jin Lee, Han-Sang Lee, Jinsun Jun, Dong-Yub Kim, Man-Young Kim, Hyunjin Kim, Hyeon Jin Kim, Hong Il Suh, Yoojin Lee, Dong Wook Kim, Jin Ho Jeong, Woo

Conclusion

AE frequently presented as seizure, but only 18.9% of the living patients suffered from seizure at 6 months after immunotherapy. Aggressive immunotherapy can improve seizure outcome in patients with AE.

Methods

Adult (age ≥18 years) patients with AE and new-onset seizure who underwent immunotherapy and were followed-up for at least 6 months were included. Seizure frequency was evaluated at 2-4 weeks and 6 months after the onset of the initial immunotherapy and was categorized as "seizure remission", "> 50% seizure reduction", or "no change" based on the degree of its decrease.

Objective

To evaluate the seizure characteristics and outcome after immunotherapy in adult patients with autoimmune encephalitis (AE) and new-onset seizure.

Results

Forty-one AE patients who presented with new-onset seizure were analysed. At 2-4 weeks after the initial immunotherapy, 51.2% of the patients were seizure free, and 24.4% had significant seizure reduction. At 6 months, seizure remission was observed in 73.2% of the patients, although four patients died during hospitalization. Rituximab was used as a second-line immunotherapy in 12 patients who continued to have seizures despite the initial immunotherapy, and additional seizure remission was achieved in 66.6% of them. In particular, those who exhibited partial response to the initial immunotherapy had a better seizure outcome after rituximab, with low adverse events.

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