Epilepsy outcomes in LGI1 and NMDA-R encephalitis
Abstract number :
310
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2020
Submission ID :
2422655
Source :
www.aesnet.org
Presentation date :
12/6/2020 12:00:00 PM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Kelsey Smith, Mayo Clinic; Divyanshu Dubey - Mayo Clinic; Greta Liebo - Mayo Clinic; Jeffrey Britton - Mayo Clinic;
Rationale:
Anti-leucine-rich glioma-inactivated 1 (LGI-1) IgG and NDMA-receptor (NDMA-R) IgG can cause autoimmune encephalitis and acute symptomatic seizures. The aim of this study was to determine seizure outcome and the proportion that developed epilepsy.
Method:
Patients with seizures related to LGI1 and NMDA-R encephalitis with ≥ 24 months of follow-up from disease onset were identified in the Mayo Clinic Rochester EMR. Charts were reviewed to determine clinical factors, seizure types, imaging, treatment, and outcome.
Results:
Fifty-eight patients (47 LGI1 and 11 NMDA-R; 36 men) were identified with a median follow-up of 57 months (IQR 33-81) from disease onset. Almost all patients (56/58) were treated with a combination of immunotherapy and anti-seizure medications (ASMs). Relapses occurred in 21/58 patients (19 LGI1 and 2 NMDA) and occurred at a higher rate in those not on chronic immunotherapy (p-value 0.03). At last follow-up (more than 2 years after the onset of autoimmune encephalitis symptoms), 6/47 (13%) of the LgI1 and 1/11 (9%) of the NMDA-R group had chronic epilepsy after resolved encephalitis. The presence of hippocampal atrophy was not associated with relapses or developing epilepsy. At last follow-up, 23/58 (40%) were still on immunotherapy and 32/58 (55%) were still on ASMs.
Conclusion:
Chronic epilepsy occurred in 7/58 (12%) of our cohort of patients with resolved LGI1 and NMDA-R encephalitis. Chronic immunotherapy was associated with a lower rate of relapse. At last follow-up, many patients were still on immunotherapy and/or ASMs.
Funding:
:None
Clinical Epilepsy