<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Background</h3>
<p>Between 14% and 20% of cases of drug-resistant epilepsy may be attributed to an impaired cellular or humoral immune response.</p>
</sec>
<sec>
<h3>Aim</h3>
<p>Our study aimed to assess disorders of the immune response of the humoral or cellular type and their impact on the course of the disease, factors suggesting the diagnosis of an autoimmune etiology. We wanted to analyse these factors, looking for correlations with a history of status epilepticus.</p>
</sec>
<sec>
<h3>Materials and methods</h3>
<p>This study prospectively analysed 30 patients who were diagnosed with drug-resistant epilepsy. The patients were divided into two groups: those who had previously experienced status epilepticus and those who had not. The study collected and analysed detailed information about the patient’s medical history, routine blood laboratory tests, albumin and immunoglobulin (IgG) levels, neuropsychological evaluations, electroencephalography tests (EEG), general cerebrospinal fluid (CSF) examinations, tests for the presence of oligoclonal bands, IgG index determination, MRZ-reaction (MRZR), chitotriosidase activity, and the presence of anti-herpes type 1 (anti-HSV-1) antibodies and neural autoantibodies. Each patient underwent magnetic resonance imaging (MRI) of the head with intravenous contrast administration using the epileptic protocol.</p>
</sec>
<sec>
<h3>Results</h3>
<p>There was no statistically significant difference in age, gender, onset and disease duration up to the time of our study. None of the patients showed the presence of the tested antibodies against neuronal surface antigens and oligoclonal bands in the CSF.</p>
</sec>
<sec>
<h3>Conclusion</h3>
<p>Lack of antibodies against neuronal antigens does not necessarily rule out autoimmune epilepsy. The exact diagnostic criteria are still a subject of debate. A history of SE increases the risk of autoimmune epilepsy.</p>
</sec>
</abstract>

Background
Between 14% and 20% of cases of drug-resistant epilepsy may be attributed to an impaired cellular or humoral immune response.


Aim
Our study aimed to assess disorders of the immune response of the humoral or cellular type and their impact on the course of the disease, factors suggesting the diagnosis of an autoimmune etiology. We wanted to analyse these factors, looking for correlations with a history of status epilepticus.


Materials and methods
This study prospectively analysed 30 patients who were diagnosed with drug-resistant epilepsy. The patients were divided into two groups: those who had previously experienced status epilepticus and those who had not. The study collected and analysed detailed information about the patient’s medical history, routine blood laboratory tests, albumin and immunoglobulin (IgG) levels, neuropsychological evaluations, electroencephalography tests (EEG), general cerebrospinal fluid (CSF) examinations, tests for the presence of oligoclonal bands, IgG index determination, MRZ-reaction (MRZR), chitotriosidase activity, and the presence of anti-herpes type 1 (anti-HSV-1) antibodies and neural autoantibodies. Each patient underwent magnetic resonance imaging (MRI) of the head with intravenous contrast administration using the epileptic protocol.


Results
There was no statistically significant difference in age, gender, onset and disease duration up to the time of our study. None of the patients showed the presence of the tested antibodies against neuronal surface antigens and oligoclonal bands in the CSF.


Conclusion
Lack of antibodies against neuronal antigens does not necessarily rule out autoimmune epilepsy. The exact diagnostic criteria are still a subject of debate. A history of SE increases the risk of autoimmune epilepsy.

Factors related to possible autoimmune etiology in patients with drug-resistant epilepsy

Journal of Epileptology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background
Between 14% and 20% of cases of drug-resistant epilepsy may be attributed to an impaired cellular or humoral immune response.


Aim
Our study aimed...

Patients n = 30	SE n = 14	None SE n = 16
Age in years	23–50 (34.21 ± 8.89)	22–65 (35.25 ±11.42)
Female	6 (42.9%)	9 (56.3%)
New-onset seizures age	0.25-19 (6.71 ± 5.18)	8-37 (15.19 ± 7.42)
Duration of the disease in years	16-46 (27.43 ± 7.89)	2-36 (20.06 ± 8.80)
Neuropsychiatric changes	4 (30.8%)	6 (37.5%)
Sleep seizures	12 (87.5%)	6 (37.5%)
Protein CSF Level > 50 mg/dl	7 (50%)	3 (18.8%)
CSF pleocytosis	4 (28.6%)	4 (25.0)
EEG findings
theta waves (> 5% EEG recording)	9 (64.3%)	3 (18.8%)
epileptiform discharges	1 (7.1%)	9 (56.3%)
MRI changes in the hippocampus	1 (7.1%)	3 (18.8%)
APE 2 score ≥ 4	7 (50%)	5 (31.3%)

Student’s t-test	SE	N	Average	Standard deviation	t	p-value
Age	.00	16	35.25	11.416	.274	.786
	1.00	14	34.21	8.894
New-onset seizures	.00	16	15.1875	7.42266	3.575	.001
	1.00	14	6.7086	5.18461
Duration of the disease	.00	16	20.06	8.797	-2.399	.023
	1.00	14	27.43	7.891
Chitotriosidase in serum (mmol/ml/h)	.00	14	46.429	33.5896	.896	.379
	1.00	14	35.614	30.2185
Chitotriosidase in CSF (mmol/ml/h)	.00	16	2.687500	1.8198443	2.240	.033
	1.00	14	1.440000	1.0807120
APE 2 score	.00	16	3.00	1.155	-.768	.449
	1.00	14	3.36	1.393

Factors related to possible autoimmune etiology in patients with drug-resistant epilepsy

Article Category: Original paper

Published Online: Nov 24, 2023

Page range: 3 - 10

Received: Jun 16, 2023

Accepted: Nov 09, 2023

DOI: https://doi.org/10.2478/joepi-2023-0001

© 2023 Magdalena Kowalska et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Demographic and clinical parameters of patients

Characteristics of patients with SE history vs those without SE history