Anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is a severe autoimmune condition, which typically affects young females. The long-term clinical consequences and brain morphology changes after anti-NMDAR encephalitis are not well known.
Objective This nationwide cohort study evaluates seizure responses to immunotherapy and antiepileptic drugs (AEDs) in patients with anti-leucine-rich glioma-inactivated 1 (LGI1), anti-NMDA receptor (NMDAR), and anti-gamma-aminobutyric-acid B receptor (GABABR) encephalitis.
Clinical utility of magnetic resonance imaging in first-episode psychosis – Volume 211 Issue 4 – Irina Falkenberg, Stefania Benetti, Marie Raffin, Phillipe Wuyts, William Pettersson-Yeo, Paola Dazzan, Kevin D.
Evaluation of seizure treatment in anti-LGI1, anti-NMDAR, and anti-GABABR encephalitis 6 May, 2019 Marienke A.A.M. de Bruijn, Agnes van Sonderen, Marleen H. van Coevorden-Hameete, Anna E.M. Bastiaansen, Marco W.J. Schreurs, Rob P.W. Rouhl, Cees A. van Donselaar, Marian H.J.M. Majoie, Rinze F. Neuteboom, Peter A.E. Sillevis Smitt, Roland D. Thijs, Maarten J. Titulaer Neurology May 2019, 92 (19) e2185-e2196 DOI: 10.1212/WNL.0000000000007475 Abstract Objective This nationwide cohort study evaluates seizure responses to immunotherapy and antiepileptic drugs (AEDs) in patients with anti-leucine-rich glioma-inactivated 1 (LGI1), anti-NMDA receptor (NMDAR), and anti-gamma-aminobutyric-acid B receptor (GABABR) encephalitis. Methods Anti-LGI1, anti-NMDAR, and anti-GABABR encephalitis patients with new-onset seizures were included. Medical information about disease course, AEDs and immunotherapies used, effects, and side effects were collected. Outcome measures were (1) seizure freedom while using AEDs or immunotherapy, (2) days to seizure freedom from start of AEDs or immunotherapy, and (3) side effects. Results Of 153 patients with autoimmune encephalitis (AIE) (53 LGI1, 75 NMDAR, 25 GABABR), 72% (n = 110) had epileptic seizures, and 89% reached seizure freedom. At least 53% achieved seizure freedom shortly after immunotherapy, and 14% achieved seizure freedom while using only AEDs (p < 0.0001). This effect was similar in all types (p = 0.0001; p = 0.0005; p = 0.013, respectively). Median time to seizure freedom from AEDs start was 59 days (interquartile range [IQR] 27–160), and 28 days from start of immunotherapy (IQR 9–71, p < 0.0001). Side effects were psychotic behavior and suicidal thoughts by the use of levetiracetam, and rash by the use of carbamazepine. Carbamazepine was more effective than levetiracetam in reducing seizures in anti-LGI1 encephalitis (p = 0.031). Only 1 patient, of 86 surviving patients, developed epilepsy after resolved encephalitis. Conclusion Epilepsy after resolved encephalitis was rare in our cohort of patients with AIE treated with immunotherapy. In addition, seizure freedom is achieved faster and more frequently after immunotherapy. Therefore, AEDs should be considered as add-on treatment, and similar to treatment of other encephalitis symptoms, immunotherapy is crucial.
In this issue of Neurology ®, de Bruijn et al.1 report the difference in efficacy between immunotherapy and antiseizure medications (ASMs) in the treatment of seizures secondary to autoimmune encephalitis.