J Clin Neurol.
2020 Oct;16(4):519-529. 10.3988/jcn.2020.16.4.519.
Clinical Approach to Autoimmune Epilepsy
- Jang Y
1 - Kim DW2
- Yang KI3
- Byun JI4
- Seo JG5
- No YJ6
- Kang KW7
- Kim D8
- Kim KT9
- Cho YW9
- Lee ST1
- on behalf of the Drug Committee of Korean Epilepsy Society
- Affiliations
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- 1Department of Neurology, Seoul National University Hospital, Seoul, Korea
- 2Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
- 3Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
- 4Department of Neurology, Kyunghee University Hospital at Gangdong, Seoul, Korea
- 5Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
- 6Department of Neurology, Samsung Noble County, Yongin, Korea
- 7Department of Neurology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
- 8Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
- 9Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
- KMID: 2506775
- DOI: http://doi.org/10.3988/jcn.2020.16.4.519
Abstract
- Autoimmune epilepsy is a newly emerging area of epilepsy. The concept of “autoimmune” as an etiology has recently been revisited thanks to advances in autoimmune encephalitis and precision medicine with immunotherapies. Autoimmune epilepsy presents with specific clinical manifestations, and various diagnostic approaches including cerebrospinal fluid analysis, neuroimaging, and autoantibody tests are essential for its differential diagnosis. The diagnosis is often indeterminate despite performing a thorough evaluation, and therefore empirical immunotherapy may be applied according to the judgment of the clinician. Autoimmune epilepsy often manifests as new-onset refractory status epilepticus (NORSE). A patient classified as NORSE should receive empirical immunotherapy as soon as possible. On the other hand, a morecautious, stepwise approach is recommended for autoimmune epilepsy that presents with episodic events. The type of autoimmune epilepsy is also an important factor to consider when choosing from among various immunotherapy options. Clinicians should additionally take the characteristics of antiepileptic drugs into account when using them as an adjuvant therapy. This expert opinion discusses the diagnostic and treatment approaches for autoimmune epilepsy from a practical point of view.
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