N Hansen1, G Widman2, J-A Witt2, J Wagner3, A J Becker4, C E Elger2, C Helmstaedter2. 1. Department of Epileptology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany. Electronic address: Niels.Hansen@ukb.uni-bonn.de. 2. Department of Epileptology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany. 3. Department of Epileptology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany; Epilepsy Centre Hessen-Marburg, Department of Neurology, University of Marburg Medical Centre, Marburg, Germany. 4. Department of Neuropathology, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany.
Abstract
OBJECTIVE: To determine the efficacy of immunotherapy in limbic encephalitis (LE) associated epilepsies with autoantibodies against intracellular antigens in the forms of paraneoplastic autoantibodies versus glutamic acid decarboxylase 65 (GAD)-autoantibodies. METHODS: Eleven paraneoplastic-antibodies+ and eleven age- and gender-matched GAD-antibodies+ patients with LE were compared regarding EEG, seizure frequency, MRI volumetry of the brain, and cognition. All patients received immunotherapy with corticosteroids add-on to antiepileptic therapy. A few patients underwent additional interventions like immunoglobulins or immunoadsorption. RESULTS: Immunotherapy led to a significantly greater proportion of seizure-free patients in the paraneoplastic antibodies+(55%) as compared to GAD-antibodies+(18%) patients (p<0.05). Impaired cognition was evident initially (total cognitive performance score based on attentional-executive function, figural/verbal memory and word fluency) in 100% of the paraneoplastic-antibodies+ and 73% of the GAD-antibodies+ group. After therapy, cognition improved significantly in the paraneoplastic-antibodies+, but not in the GAD-antibodies+ patients (p<0.05). Cognitive change did not correlate with the change in the number of antiepileptic drugs over time. MRI showed larger and unchanged volumes of the amygdala, presubiculum and subiculum in GAD-antibodies+as compared to paraneoplastic-antibodies+patients (p<0.05) over time. CONCLUSIONS: Our data provide evidence of a beneficial effect of immunotherapy added to antiepileptic drugs on seizure frequency and cognition only in the paraneoplastic-antibodies+ subgroup of LE presenting autoantibodies against intracellular antigens.
OBJECTIVE: To determine the efficacy of immunotherapy in limbic encephalitis (LE) associated epilepsies with autoantibodies against intracellular antigens in the forms of paraneoplastic autoantibodies versus glutamic acid decarboxylase 65 (GAD)-autoantibodies. METHODS: Eleven paraneoplastic-antibodies+ and eleven age- and gender-matched GAD-antibodies+ patients with LE were compared regarding EEG, seizure frequency, MRI volumetry of the brain, and cognition. All patients received immunotherapy with corticosteroids add-on to antiepileptic therapy. A few patients underwent additional interventions like immunoglobulins or immunoadsorption. RESULTS: Immunotherapy led to a significantly greater proportion of seizure-free patients in the paraneoplastic antibodies+(55%) as compared to GAD-antibodies+(18%) patients (p<0.05). Impaired cognition was evident initially (total cognitive performance score based on attentional-executive function, figural/verbal memory and word fluency) in 100% of the paraneoplastic-antibodies+ and 73% of the GAD-antibodies+ group. After therapy, cognition improved significantly in the paraneoplastic-antibodies+, but not in the GAD-antibodies+ patients (p<0.05). Cognitive change did not correlate with the change in the number of antiepileptic drugs over time. MRI showed larger and unchanged volumes of the amygdala, presubiculum and subiculum in GAD-antibodies+as compared to paraneoplastic-antibodies+patients (p<0.05) over time. CONCLUSIONS: Our data provide evidence of a beneficial effect of immunotherapy added to antiepileptic drugs on seizure frequency and cognition only in the paraneoplastic-antibodies+ subgroup of LE presenting autoantibodies against intracellular antigens.
Authors: Christoph Mueller; Lisa Langenbruch; Johanna M H Rau; Tobias Brix; Christine Strippel; Andre Dik; Kristin S Golombeck; Constanze Mönig; Andreas Johnen; Saskia Räuber; Heinz Wiendl; Sven G Meuth; Jens Bölte; Stjepana Kovac; Nico Melzer Journal: Arch Clin Neuropsychol Date: 2022-05-16 Impact factor: 3.448
Authors: Amina E Essawy; Soad Ahmed El-Sayed; Ehab Tousson; Horeya S Abd El-Gawad; Reem Hasaballah Alhasani; Heba-Tallah Abd Elrahim Abd Elkader Journal: Environ Sci Pollut Res Int Date: 2022-02-22 Impact factor: 5.190