Skip to main content

Treating Immune-Related Epilepsy

Abstract

Purpose of Review

This review explores different treatment modalities for immune-mediated epilepsy, including epilepsy caused by autoantibodies as well as epilepsy in the context of systemic autoimmune disease.

Recent Findings

Autoimmune epilepsy is an increasingly recognized entity. Conventional treatments for epilepsy, such as antiseizure medications and epilepsy surgery, are less successful in treating epilepsy caused by autoimmune disease. Immunomodulatory therapies such as corticosteroids, intravenous immunoglobulin, and plasma exchange are generally more successful in treating immune-mediated epilepsy than conventional epilepsy therapies.

Summary

Autoimmune epilepsy should be considered as a possible etiology for patients with frequent seizures of unknown etiology. The response to immunotherapies is often promising, particularly in patients with antibodies to neuronal cell surface antigens.

This is a preview of subscription content, access via your institution.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Falco-Walter JJ, Scheffer IE, Fisher RS. The new definition and classification of seizures and epilepsy. Epilepsy Res. 2017;139:73–9.

    Article  PubMed  Google Scholar 

  2. Brenner T, Sills GJ, Hart Y, Howell S, Waters P, Brodie MJ, et al. Prevalence of neurologic autoantibodies in cohorts of patients with new and established epilepsy. Epilepsia. 2013;54(6):1028–35. https://doi.org/10.1111/epi.12127.

    Article  PubMed  Google Scholar 

  3. •• Dubey D, Algallaf A, Hayes R, Freeman M, Chen K, Ding K, et al. Neurologic autoantibody prevalence in epilepsy of unknown etiology. JAMA Neurol. 2017;74(4):397–402. This study indicates that autoantibodies may be detected in up to 35% of patients with epilepsy of unknown etiology; furthermore, it identifies clinical characteristics that predict the presence of autoantibodies. https://doi.org/10.1001/jamaneurol.2016.5429.

    Article  PubMed  Google Scholar 

  4. •• Quek AM, Britton JW, McKeon A, So E, Lennon VA, Shin C, et al. Autoimmune epilepsy: clinical characteristics and response to immunotherapy. Arch Neurol. 2012;69(5):582–93. This study demonstrated that the majority of patients with known or suspected autoimmune epilepsy will demonstrated a response to immunotherapy within a median time of four months. https://doi.org/10.1001/archneurol.2011.2985.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vincent A, Buckley C, Schott JM, Baker I, Dewar BK, Detert N, et al. Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis. Brain. 2004;127(3):701–12. https://doi.org/10.1093/brain/awh077.

    Article  PubMed  Google Scholar 

  6. Lai M, Huijbers MG, Lancaster E, Graus F, Bataller L, Balice-Gordon R, et al. Investigation of LGI1 as the antigen in limbic encephalitis previously attributed to potassium channels: a case series. Lancet Neurol. 2010;9(8):776–85. https://doi.org/10.1016/S1474-4422(10)70137-X.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D, et al. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79(11):1094–100. https://doi.org/10.1212/WNL.0b013e3182698cd8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zuliani L, Graus F, Giometto B, Bien C, Vincent A. Central nervous system neuronal surface antibody associated syndromes: review and guidelines for recognition. J Neurol Neurosurg Psychiatry. 2012;83(6):638–45. https://doi.org/10.1136/jnnp-2011-301237.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;4:391–404.

    Article  Google Scholar 

  10. Dahm L, Ott C, Steiner J, Stepniak B, Teegen B, Saschenbrecker S, et al. Seroprevalence of autoantibodies against brain antigens in health and disease. Ann Neurol. 2014;76(1):82–94. https://doi.org/10.1002/ana.24189.

    CAS  Article  PubMed  Google Scholar 

  11. Leypoldt F, Armangue T, Dalmau J. Autoimmune encephalopathies. Ann N Y Acad Sci. 2015;1338(1):94–114. https://doi.org/10.1111/nyas.12553.

    CAS  Article  PubMed  Google Scholar 

  12. Gresa-Arribas N, Titulaer MJ, Torrents A, Aguilar E, McCracken L, Leypoldt F, et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol. 2014;2:167–77.

    Article  Google Scholar 

  13. McCracken L, Zhang J, Greene M, Crivaro A, Gonzalez J, Kamoun M, et al. Improving the antibody-based evaluation of autoimmune encephalitis. Neurol Neuroimmunol Neuroinflamm. 2017;4(6):e404. https://doi.org/10.1212/NXI.0000000000000404.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain. 2000;123(7):1481–94. https://doi.org/10.1093/brain/123.7.1481.

    Article  PubMed  Google Scholar 

  15. Irani SR, Michell AW, Lang B, Pettingill P, Waters P, Johnson MR, et al. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Ann Neurol. 2011;69(5):892–900. https://doi.org/10.1002/ana.22307.

    Article  PubMed  Google Scholar 

  16. Lai M, Hughes EG, Peng X, Zhou L, Gleichman AJ, Shu H, et al. AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Ann Neurol. 2009;65(4):424–34. https://doi.org/10.1002/ana.21589.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. Höftberger R, Titulaer MJ, Sabater L, Dome B, Rózsás A, Hegedus B, et al. Encephalitis and GABAB receptor antibodies: novel findings in a new case series of 20 patients. Neurology. 2013;81(17):1500–6. https://doi.org/10.1212/WNL.0b013e3182a9585f.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Titulaer MJ, Soffietti R, Dalmau J, Gilhus NE, Giometto B, Graus F, et al. Screening for tumors in paraneoplastic syndromes: report of an EFNS task force. Eur J Neurol. 2011;18(1):19–e3. https://doi.org/10.1111/j.1468-1331.2010.03220.x.

    CAS  Article  PubMed  Google Scholar 

  19. Suleiman J, Brilot F, Lang B, Vincent A, Dale RC. Autoimmune epilepsy in children: case series and proposed guidelines for identification. Epilepsia. 2013;6:1036–45.

    Article  Google Scholar 

  20. •• Feyissa AM, Lόpez Chiriboga AS, Britton JW. Antiepileptic drug therapy in patients with autoimmune epilepsy. Neurol Neuroimmunol Neuroinflamm. 2017;4(4):e353. This study demonstrates the poor response most patients with autoimmune epilepsy have to traditional antiseizure medications, particularly in comparison with immunotherapy. https://doi.org/10.1212/NXI.0000000000000353.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Malter MP, Frisch C, Zeitler H, Surges R, Urbach H, Helmstaedter C, et al. Treatment of immune-mediated temporal lobe epilepsy with GAD antibodies. Seizure. 2015;30:57–63. https://doi.org/10.1016/j.seizure.2015.05.017.

    CAS  Article  PubMed  Google Scholar 

  22. Irani SR, Stagg CJ, Schott JM, Rosenthal CR, Schneider SA, Pettingill P, et al. Faciobrachial dystonic seizures: the influence of immunotherapy on seizure control and prevention of cognitive impairment in a broadening phenotype. Brain. 2013;136(Pt 10):3151–62. https://doi.org/10.1093/brain/awt212.

    Article  PubMed  Google Scholar 

  23. Beghi E, Shorvon S. Antiepileptic drugs and the immune system. Epilepsia. 2011;52:40–4. https://doi.org/10.1111/j.1528-1167.2011.03035.x.

    Article  PubMed  Google Scholar 

  24. Bianchi M, Rossoni G, Sacerdote P, Panerai AE, Berti F. Carbamazepine exerts anti-inflammatory effects in the rat. Eur J Pharmacol. 1995;294(1):71–4. https://doi.org/10.1016/0014-2999(95)00516-1.

    CAS  Article  PubMed  Google Scholar 

  25. Himmerich H, Bartsch S, Hamer H, Mergl R, Schönherr J, Petersein C, et al. Modulation of cytokine production by drugs with antiepileptic or mood stabilizer properties in anti-CD3- and anti-Cd40-stimulated blood in vitro. Oxidative Med Cell Longev. 2014;2014:8061–2.

    Article  Google Scholar 

  26. Almeida V, Pimentel J, Campos A, Bentes C, Maruta C, Morgado C, et al. Surgical control of limbic encephalitis associated with LGI1 antibodies. Epileptic Disord. 2012;14:345–8.

    PubMed  Google Scholar 

  27. •• Carreño M, Bien CG, Asadi-Pooya AA, Sperling M, Marusic P, Elisak M, et al. Epilepsy surgery in drug resistant temporal lobe epilepsy associated with neuronal antibodies. Epilepsy Res. 2017;129:101–5. This study demonstrates that patients with neuronal antibody have a low likelihood of an Engel class I outcome following epilepsy surgery. https://doi.org/10.1016/j.eplepsyres.2016.12.010.

    Article  PubMed  Google Scholar 

  28. Muehlebner A, Groeppel G, Pahs G, Hainfellner JA, Prayer D, Czech T, et al. Beneficial effect of epilepsy surgery in a case of childhood non-paraneoplastic limbic encephalitis. Epilepsy Res. 2010;90(3):295–9. https://doi.org/10.1016/j.eplepsyres.2010.05.009.

    Article  PubMed  Google Scholar 

  29. Mathon B, Bédos Ulvin L, Adam C, Adam C, Baulac M, Dupont S, et al. Surgical treatment for mesial temporal lobe epilepsy associated with hippocampal sclerosis. Rev Neurol (Paris). 2015;171(3):315–25. https://doi.org/10.1016/j.neurol.2015.01.561.

    CAS  Article  Google Scholar 

  30. Sakuma H, Awaya Y, Shiomi M, Yamanouchi H, Takahashi Y, Saito Y, et al. Acute encephalitis with refractory, repetitive partial seizures (AERRPS): a peculiar form of childhood encephalitis. Acta Neurol Scand. 2010;121(4):251–6. https://doi.org/10.1111/j.1600-0404.2009.01198.x.

    CAS  Article  PubMed  Google Scholar 

  31. Gaspard N, Foreman BP, Alvarez V, Cabrera Kang C, Probasco JC, Jongeling AC, et al. New-onset refractory status epilepticus: etiology, clinical features, and outcome. Neurology. 2015;85(18):1604–13. https://doi.org/10.1212/WNL.0000000000001940.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kramer U, Chi CS, Lin KL, Specchio N, Sahin M, Olson H, et al. Febrile infection-related epilepsy syndrome (FIRES): pathogenesis, treatment, and outcome: a multicenter study on 77 children. Epilepsia. 2011;52(11):1956–65. https://doi.org/10.1111/j.1528-1167.2011.03250.x.

    Article  PubMed  Google Scholar 

  33. Thakur KT, Probasco JC, Hocker SE, Roehl K, Henry B, Kossoff EH, et al. Ketogenic diet for adults in super-refractory status epilepticus. Neurology. 2014;8:665–70.

    Article  Google Scholar 

  34. Petit-Pedrol M, Armangue T, Peng X, Bataller L, Cellucci T, Davis R, et al. Encephalitis with refractory seizures, status epilepticus, and antibodies to the GABAA receptor: a case series, characterization of the antigen, and analysis of the effects of antibodies. Lancet Neurol. 2014;13(3):276–86. https://doi.org/10.1016/S1474-4422(13)70299-0.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  35. Appavu B, Vanatta L, Condie J, Kerrigan JF, Jarrar R, et al. Ketogenic diet treatment for pediatric super-refractory status epilepticus. Seizure. 2016;41:62–5. https://doi.org/10.1016/j.seizure.2016.07.006.

    Article  PubMed  Google Scholar 

  36. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. 2011;10:Lancet Neurol, 63–74.

  37. •• Toledano M, Britton JW, McKeon A, Shin C, Lennon VA, Quek AM, et al. Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy. Neurology. 2014;82(18):1578–86. This study demonstrated that immunotherapy with methylprednisolone or IVIG produces a high rate of seizure reduction/seizure freedom in patients with suspected autoimmunity, even in the absence of an identified autoantibody. https://doi.org/10.1212/WNL.0000000000000383.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  38. American College of Rheumatology Ad Hoc Committee on glucocorticoid-induced osteoporosis. Arthritis Rheum. 2001; 44(7):1496–503.

  39. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis Ann Intern Med. 1991;115(10):787–96. https://doi.org/10.7326/0003-4819-115-10-787.

    CAS  Article  PubMed  Google Scholar 

  40. Stern A, Green H, Paul M, Vidal L, Leibovici L. Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database Syst Rev. 2014:(10):CD005590.

  41. Suleiman J, Dale RC. The recognition and treatment of autoimmune epilepsy in children. Dev Med Child Neurol. 2015;57(5):431–40. https://doi.org/10.1111/dmcn.12647.

    Article  PubMed  Google Scholar 

  42. Irani SR, Gelfand JM, Bettcher BM, Singhal NS, Geshwind MD. Effect of rituximab in patients with leucine-rich, glioma-inactivated 1 antibody-associated encephalopathy. JAMA Neurol. 2014;71(7):896–900. https://doi.org/10.1001/jamaneurol.2014.463.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Wong SH, Saunders MD, Larner AJ, Das K, Hart IK. An effective immunotherapy regimen for VGKC antibody-positive limbic encephalitis. J Neurol Neurosurg Psychiatry. 2010;81(10):1167–9. https://doi.org/10.1136/jnnp.2009.178293.

    CAS  Article  PubMed  Google Scholar 

  44. Toledano M, Pittock SJ. Autoimmune epilepsy. Semin Neurol. 2015;35(03):245–58. https://doi.org/10.1055/s-0035-1552625.

    Article  PubMed  Google Scholar 

  45. Dogan Onugoren M, Deuretzbacher D, Haensch CA, Hagedorn HJ, Halve S, Isenmann S, et al. Limbic encephalitis due to GABAB and AMPA receptor antibodies: a case series. J Neurol Neurosurg Psychiatry. 2015;86(9):965–72. https://doi.org/10.1136/jnnp-2014-308814.

    CAS  Article  PubMed  Google Scholar 

  46. Carvajal-González A, Leite MI, Waters P, Woodhall M, Coutinho E, Balint B, et al. Glycine receptor antibodies in PERM and related syndromes: characteristics, clinical features and outcomes. Brain. 2014;137(Pt 8):2178–92. https://doi.org/10.1093/brain/awu142.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Guan HZ, Ren HT, Yang XZ, Lu Q, Peng B, Zhu YC, et al. Limbic encephalitis associated with anti-γ-aminobutyric acid B receptor antibodies: a case series from China. Chin Med J. 2015;128(22):3023–8. https://doi.org/10.4103/0366-6999.168989.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Cui J, Bu H, He J, Zhao Z, Han W, Gao R, et al. The gamma-aminobutyric acid-B receptor (GABAB) encephalitis: clinical manifestations and response to immunotherapy. Int J Neurosci. 2017;6:1–7.

    Article  Google Scholar 

  49. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008;7(12):1091–8. https://doi.org/10.1016/S1474-4422(08)70224-2.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  50. Dalmau J, Graus F, Rosenblum MK, Posner JB. Anti-Hu-associated paraneoplastic encephalomyelitis/sensory neuronopathy. A clinical study of 71 patients. Medicine (Baltimore). 1992;71(2):59–72. https://doi.org/10.1097/00005792-199203000-00001.

    CAS  Article  Google Scholar 

  51. Murinson CC, Guarnaccia JB. Stiff-person syndrome with amphiphysin antibodies: distinctive features of a rare disease. Neurology. 2008: Dec 9;71(24):1955–8. https://doi.org/10.1212/01.wnl.0000327342.58936.e0.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  52. Sillevis Smitt P, Grefkens J, de Leeuw B, van den Bent M, van Putten W, Hooijkaas H, et al. Survival and outcome in 73 anti-Hu positive patients with paraneoplastic encephalomyelitis/sensory neuronopathy. J Neurol. 2002;249(6):745–53. https://doi.org/10.1007/s00415-002-0706-4.

    Article  PubMed  Google Scholar 

  53. Meinck HM, Faber L, Morgenthaler N, Seissler J, Maile S, Butler M, et al. Antibodies against glutamic acid decarboxylase: prevalence in neurological diseases. J Neurol Neurosurg Psychiatry. 2001;71(1):100–3. https://doi.org/10.1136/jnnp.71.1.100.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  54. Gagnon MM, Savard M. Limbic encephalitis associated with GAD65 antibodies: brief review of the relevant literature. Can J Neurol Sci. 2016;43(4):486–93. https://doi.org/10.1017/cjn.2016.13.

    Article  PubMed  Google Scholar 

  55. Douglas CA, Ellershaw J. Anti-Hu antibodies may indicate a positive response to chemotherapy in paraneoplastic syndrome secondary to small cell lung cancer. Palliat Med. 2013;17:638–9.

    Article  Google Scholar 

  56. Orange D, Frank M, Tian S, Dousmanis A, Marmur R, Buckley N, et al. Cellular immune suppression in paraneoplastic neurologic syndromes targeting intracellular antigens. Arch Neurol. 2012;69(9):1132–40. https://doi.org/10.1001/archneurol.2012.595.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Bertsias GK, Ionnidis JP, Aringer M, Bollen E, Bombardieri S, Bruce IN, et al. EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. Ann Rheum Dis. 2010;69(12):2074–82. https://doi.org/10.1136/ard.2010.130476.

    CAS  Article  PubMed  Google Scholar 

  58. Atwater BD, Ai Z, Wolff MR. Fulminant myopericarditis from phenytoin-induced systemic lupus erythematosus. WMJ. 2008;107(6):298–300.

    PubMed  Google Scholar 

  59. Barile-Fabris L, Ariza-Andraca R, Olguín-Ortega L, Jara LJ, Fraga-Mouret A, Miranda-Limón JM, et al. Controlled trial of IV cyclophosphamide versus IV methylprednidolone in severe neurological manifestations in systemic lupus erythematosus. Ann Rheum Dis. 2005;64(4):620–5. https://doi.org/10.1136/ard.2004.025528.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  60. Vasconcellos E, Pina-Garza JE, Fakhoury T, Fenichel GM. Pediatric manifestations of Hashimoto’s encephalopathy. Pediatr Neurol. 1999;20(5):394–8. https://doi.org/10.1016/S0887-8994(99)00006-5.

    CAS  Article  PubMed  Google Scholar 

  61. Olmez I, Moses H, Sriram S, Kirshner H, Lagrange AH, Pawate S. Diagnostic and therapeutic aspects of Hashimoto’s encephalopathy. J Neurol Sci. 2013;331(1-2):67–71. https://doi.org/10.1016/j.jns.2013.05.009.

    Article  PubMed  Google Scholar 

  62. Chong JY, Rowland LP, Utiger RD. Hashimoto encephalopathy: syndrome or myth? Arch Neurol. 2003;60(2):164–71. https://doi.org/10.1001/archneur.60.2.164.

    Article  PubMed  Google Scholar 

  63. Stern BJ, Krumholz A, Johns C, Scott P, Nissim J. Sarcoidosis and its neurological manifestations. Arch Neurol. 1985;42(9):909–17. https://doi.org/10.1001/archneur.1985.04060080095022.

    CAS  Article  PubMed  Google Scholar 

  64. Baumann RJ, Robertson WC Jr. Neurosarcoid presents differently in children than in adults. Pediatrics. 2003;112(6):e480–6. https://doi.org/10.1542/peds.112.6.e480.

    Article  PubMed  Google Scholar 

  65. Malmgren K, Lycke J, Engman E, Hedström A, Jönsson L, Rydenhag B, et al. Successful epilepsy surgery in a patient with neurosarcoidosis. Epilepsia. 2010;51(6):1101–3. https://doi.org/10.1111/j.1528-1167.2010.02580.x.

    Article  PubMed  Google Scholar 

  66. Lorentzen AO, Sveberg L, Midtvedt O, Kerty E, Heuser K. Overnight response to infliximab in neurosarcoidosis: a case report and review of infliximab treatment practice. Clin Neuropharmacol. 2014;37(5):142–8. https://doi.org/10.1097/WNF.0000000000000047.

    CAS  Article  PubMed  Google Scholar 

  67. Marnane M, Lynch T, Scott J, Stack J, Kelly PJ. Steroid-unresponsive neurosarcoidosis successfully treated with adalimumab. J Neurol. 2009;256(1):139–40.

    Article  PubMed  Google Scholar 

  68. Alaedini A, Okamoto H, Briani C, Wollenberg K, Shill HA, Bushara KO, et al. Immune cross-reactivity in celiac disease: anti-gliadin antibodies bind to neuronal synapsin I. J Immunol. 2007;178(10):6590–5. https://doi.org/10.4049/jimmunol.178.10.6590.

    CAS  Article  PubMed  Google Scholar 

  69. Chapman RW, Laidlow JM, Colin-Jone D, Eade OE, Smith CL. Increased prevalence of epilepsy in celiac disease. BMJ. 1978;22:250–1.

    Article  Google Scholar 

  70. Hadijvassiliou M, Grünewald RA, Davies-Jones GA. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry. 2002;72(5):560–3. https://doi.org/10.1136/jnnp.72.5.560.

    Article  Google Scholar 

  71. Ventura A, Bouquet F, Sartorelli C, Barbi E, Torre G, Tommasini G, et al. Coeliac disease, folic acid deficiency and epilepsy with cerebral calcifications. Acta Pediatr Scand. 1991;80(5):559–62. https://doi.org/10.1111/j.1651-2227.1991.tb11906.x.

    CAS  Article  Google Scholar 

  72. Bye AM, Andermann F, Robitaille Y, Oliver M, Bohane T, Andermann E. Cortical vascular abnormalities in the syndrome of celiac disease, epilepsy, bilateral occipital calcifications and folate deficiency. Ann Neurol. 1993;34(3):399–403. https://doi.org/10.1002/ana.410340316.

    CAS  Article  PubMed  Google Scholar 

  73. Bashiri H, Afshari D, Babaei N, Ghadami MR. Celiac disease and epilepsy: the effect of gluten-free diet on seizure control. Adv Clin Exp Med. 2016;25(4):751–4. https://doi.org/10.17219/acem/43585.

    Article  PubMed  Google Scholar 

  74. Krumholz A, Stern BJ, Stern EG. Clinical implications of seizures in neurosarcoidosis. Arch Neurol. 1991;48(8):842–4. https://doi.org/10.1001/archneur.1991.00530200084023.

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sarah E. Schmitt.

Ethics declarations

Conflict of Interest

Sonal Bhatia declares no conflict of interest.

Sarah E. Schmitt has received personal fees from SAGE Therapeutics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical collection on Epilepsy

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bhatia, S., Schmitt, S.E. Treating Immune-Related Epilepsy. Curr Neurol Neurosci Rep 18, 10 (2018). https://doi.org/10.1007/s11910-018-0821-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-018-0821-y

Keywords

  • Autoimmune epilepsy
  • Encephalitis
  • Treatment
  • Immunotherapy