Immune Mediated Epilepsy
محل انتشار: پانزدهمین کنگره بین المللی صرع ایران
سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 366
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شناسه ملی سند علمی:
EPILEPSEMED15_122
تاریخ نمایه سازی: 29 اردیبهشت 1398
چکیده مقاله:
Immune mediated epilepsy is one of the fastest growing topics in the field of neurology. Approximately one third of the patients that go through medical treatment don’t respond well to medical therapy. A subset of these patients has an epilepsy resulting from an immune disorder with seizures as a main symptom.Autoimmune encephalitis is characterized by subacute development and rapid progression of working memory deficit, lethargy, personality changes or psychiatric symptoms and seizures. The underlying mechanism of disease is autoantibodies against neuronal intracellular (ANNA-1,CRMP-5, GAD65,Ma/Ta) or surface cell (NMDAR, LGI-1, AMPAR, GABAR,CASPR2, DPPX) proteins.An autoimmune mediated epilepsy is suspected based on presence of medically intractable seizures and the presence of at least one neural antibody and inflammatory changes found in CSF or MRI or presence of family history of autoimmune disease. Recently there has been scoring system developed which is called antibody prevalence in epilepsy of unknown etiology score (APE).This indicated scoring system measures clinical symptoms, brain MRI and CSF findings and the presence of malignancy. An APE score≥4predicts a high possibility of an autoimmune etiology.Currently there is no data regarding the treatment of autoimmune epilepsy from randomized controlled trial.First line of treatment is usually consist of intravenous methylprednisolone (1g/dayfor3to5days) and/or intravenous immunoglobulin (IVIG) (0.4 g/kg/day for 3-5 days).If there is no response to the first line,it is essential to try the second line.(Rituximab, Cyclophosphamide). Autoimmune epilepsy should be considered in any patient with newly diagnosed drug resistant epilepsy. Early diagnosis and appropriate treatment could improve the clinical course and prognosis in these patients.
نویسندگان
Behnam Safarpour Lima
Fellowship of Epilepsy, Assistant Professor of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.