Rationale: Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of antiphospholipid antibodies (aPL) and a predisposition thrombosis and noninfectious endocarditis which may lead to stroke. However, APS also has other neurological manifestations including migraine, seizures, and cognitive impairment unrelated to cerebrovascular sequela. With the increased prevalence of APS in the setting of COVID-19, these neurological manifestations are becoming more common. The goal of this case series is to review the neurological manifestations, imaging findings, EEG findings and seizure semiology in patients with epilepsy that meet criteria for APS.
Methods:
Four patients were evaluated for seizures of unknown etiology. Patients where found to have antiphophospholipid antibody positivity. Specific antiphophospholipid antibody type, EEG findings, seizure semiology, seizure frequency, and response to therapy were reviewed and tabulated for common features.
Results:
Of the 4 patients with antiphospholipid syndrome, the two patients with positive Phospholipid antibody demonstrated a seizure semiology with neuropsychiatric phenomena and dizziness, while the two patients with Beta 2 GP1 antibody had a seizure semiology with amnestic episodes consistent with transient epileptic amnesia. EEGs were significant for bitemporal abnormalities including frequent temporal sharp waves and epochs of intermittent rhythmic delta.
Conclusions:
Antiphophoslipid syndrome is an under recognized etiology for autoimmune epilepsy. This case series aims to characterize the seizure semiology, imaging findings, EEG findings, and response to anti seizure medication. The secondary aim is to increase awareness of this association given the increased prevalence of Antiphophoslipid syndrome in patients with COVID-19.
Funding: None