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Neurological autoantibodies in drug-resistant epilepsy of unknown cause

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Autoimmune epilepsy is a rarely diagnosed condition. Recognition of the underlying autoimmune condition is important, as these patients can be resistant to antiepileptic drugs.

Aims

To determine the autoimmune and oncological antibodies in adult drug-resistant epilepsy of unknown cause and identify the clinical, radiological, and EEG findings associated with these antibodies according to data in the literature.

Methods

Eighty-two patients with drug-resistant epilepsy of unknown cause were prospectively identified. Clinical features were recorded. The levels of anti-voltage-gated potassium channel complex (anti-VGKCc), anti-thyroid peroxidase (anti-TPO), anti-nuclear antibody (ANA), anti-glutamic acid decarboxylase (anti-GAD), anti-phospholipid IgG and IgM, anti-cardiolipin IgG and IgM, and onconeural antibodies were determined.

Results

Serum antibody positivity suggesting the potential role of autoimmunity in the aetiology was present in 17 patients with resistant epilepsy (22.0%). Multiple antibodies were found in two patients (2.6%). One of these patients (1.3%) had anti-VGKCc and ANA, whereas another (1.3%) had anti-VGKCc and anti-TPO. A single antibody was present in 15 patients (19.5%). Of the 77 patients finally included in the study, 4 had anti-TPO (5.2%), 1 had anti-GAD (1.3%), 4 had anti-VGKCc (5.2%) 8 had ANA (10.3%), and 2 had onconeural antibodies (2.6%) (1 patient had anti-Yo and 1 had anti-MA2/TA). The other antibodies investigated were not detected. EEG abnormality (focal), focal seizure incidence, and frequent seizures were more common in antibody-positive patients.

Conclusion

Autoimmune factors may be aetiologically relevant in patients with drug-resistant epilepsy of unknown cause, especially if focal seizures are present together with focal EEG abnormality and frequent seizures.

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Funding

This study was supported by the İnönü University Scientific Project Unit (Project no. 2016-64).

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Authors and Affiliations

  1. Department of Neurology, Inonu University, School of Medicine, Malatya, Turkey

    Mehmet Tecellioglu, Ozden Kamisli, Suat Kamisli & Cemal Ozcan

  2. Department of Neurology, Malatya State Hospital, Malatya, Turkey

    Fatma Ebru Yucel

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  1. Mehmet Tecellioglu
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Correspondence to Mehmet Tecellioglu.

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Informed consent was obtained from all individual participants included in the study.

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All procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Tecellioglu, M., Kamisli, O., Kamisli, S. et al. Neurological autoantibodies in drug-resistant epilepsy of unknown cause. Ir J Med Sci 187, 1057–1063 (2018). https://doi.org/10.1007/s11845-018-1777-2

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  • DOI: https://doi.org/10.1007/s11845-018-1777-2

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