Abstracts

Rationale: Rationale: There is a growing interest in etiopathogenesis and management of autoimmune epilepsy. Often epilepsy is a part of an autoimmune encephalitis syndrome, presenting with neuropsychiatric symptoms, memory loss, or movements disorders. Various neuronal autoantibodies have been associated with these syndromes. No clear management guidelines exist due to lack of prospective trials or large retrospective studies. Commonly used management strategies include optimizing antiepileptic drugs, tumor removal (if identified) and use of immunomodulatory agents. Objective: To assess clinical and electrographic characteristics of patients with autoimmune epilepsy. We also aimed to evaluate the effect of immunomodulatory therapy on reduction of seizure frequency among various antibody groups and patients with or without underlying malignancy. Methods: Methods: Observational retrospective case series, conducted using electronic medical data from two teaching hospitals (Parkland Memorial Hospital and UT Southwestern University Hospital). Clinical data was collected from January 2008 to December 2013. Cases were selected based on pre-specified inclusion and exclusion criteria. Results: Results: 30 patients with autoimmune epilepsy were identified. Mean age of study participants was 45.50 years (SD 16.67) and 70% (21) of the patients were males. 23% (7) of patients had an underlying malignancy. Specific autoimmune antibodies were detected in 76.7% (23) of patients; VGKc 23.3% (7), NMDA-R 23.3% (7), anti-thyroid 16.7% (5), GAD 6.7% (2), GABA_B 6.7% (2). Electrographic seizures were documented in 63% (19) of patients in our institution; of these 15 had temporal lobe onset and 4 had an extra-temporal foci. The remaining 11 patients had clinical or electrographic evidence of seizures at an outside hospital. One third of study participants had only electrographic seizures, without clinical correlate; while 13 of 19 patients were discovered to have focal status epilepticus on vEEG monitoring. Mean daily seizures for patients during initial prolonged VEEG monitoring were 3.83 (SD 1.4); average number of anti-seizure drugs used was 2.3 (SD 8). 63.3% (19) of study participants had 50% reduction in seizure frequency at the first clinic visit, following inpatient management of acute episode. Mean time to follow-up in clinic was 53.43 days (SD 21.59). 93% (28) patient received immunomodulatory therapies, including steroids (86.7%), plasmapheresis (60%), IVIG (26.7%), Rituximab (26.7%), mycophenolate (16.7%), cyclophosphamide (10%). There was no significant difference in outcomes based on gender, race, age, hospital location or type of antibody. Patients with no underlying malignancy had significantly better clinical outcome (p=0.043). Conclusions: Conclusion: This study highlights certain important clinical, electrographic and therapeutic aspects of autoimmune epilepsy. Among our study participants autoimmune epilepsies without underlying malignancy showed better clinical outcome. Early initiation of immunomodulatory therapy may prove to be beneficial for these patients, but further research is needed.