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Semin Neurol 2018; 38(03): 290-302
DOI: 10.1055/s-0038-1660860
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Autoimmune Epilepsy: The Evolving Science of Neural Autoimmunity and Its Impact on Epilepsy Management

Amy M.L. Quek
1   Division of Neurology, Department of Medicine, National University Hospital, Singapore
2   Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
,
Orna O'Toole
3   Department of Neurology, Mercy University Hospital, Grenville Place, Cork, Ireland
› Author Affiliations
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Publication History

Publication Date:
16 July 2018 (online)

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Abstract

Autoimmune epilepsy is increasingly recognized as a distinct clinical entity, driven in large part by the recent discovery of neural autoantibodies in patients with isolated or predominant epilepsy presentations. Detection of neural autoantibodies in high-risk epilepsy patients supports an immune-mediated cause of seizures and, if applicable, directs the search for an underlying cancer when the paraneoplastic association of the associated antibody is compelling. Early diagnosis of autoimmune epilepsy is crucial, as prompt initiation of immunosuppressive treatment increases the likelihood of achieving either seizure freedom or a substantial reduction in seizure frequency. A practical clinical approach that incorporates risk scores to guide patient selection on the basis of clinical features, neural autoantibodies, and a treatment trial of immunotherapy is suggested. Elucidating an immunological basis of epilepsy provides neurologists with wider treatment options (incorporating immune-suppressive treatment), in addition to standard antiepileptic drugs, which often improves patient outcomes.

Keywords

autoimmune - epilepsy - encephalitis - seizures - antibodies