Population-level evidence for an autoimmune etiology of epilepsy.
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ABSTRACT:
SUBMITTER: Ong MS
PROVIDER: S-EPMC4324719 | biostudies-literature | 2014 May
REPOSITORIES: biostudies-literature
Publications
Population-level evidence for an autoimmune etiology of epilepsy.
Ong Mei-Sing MS Kohane Isaac S IS Cai Tianxi T Gorman Mark P MP Mandl Kenneth D KD
JAMA neurology 20140501 5
<h4>Importance</h4>Epilepsy is a debilitating condition, often with neither a known etiology nor an effective treatment. Autoimmune mechanisms have been increasingly identified.<h4>Objective</h4>To conduct a population-level study investigating the relationship between epilepsy and several common autoimmune diseases.<h4>Design, setting, and participants</h4>A retrospective population-based study using claims from a nationwide employer-provided health insurance plan in the United States. Particip ...[more]
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Project description:IntroductionLate-onset epilepsy (LOE) has recently become a topic of intense research. Besides stroke, tumors, and dementia, autoimmune encephalitis (AE) has emerged as another possible cause of recurrent seizures in the elderly, and may account for a proportion of cases of LOE of unknown origin (LOEUO). This 24-h ambulatory electroencephalography (AEEG)-based study compared patients with LOEUO and AE to identify features suggestive of immune-mediated seizures in the elderly.Materials and methodsWe retrospectively reviewed 232 AEEG examinations performed in patients over 55 years with ≥6-month follow-up, and selected 21 subjects with AE and 25 subjects with LOEUO. Clinical charts and AEEG recordings were carefully analyzed.ResultsTwenty-five patients with LOEUO (12 women, mean age at onset 67.9 years) and 21 AE subjects (8 women, mean age at onset 65.7 years) were enrolled. High-frequency seizures were reported in 20/21 AE and 7/25 LOEUO cases (p < 0.00001). Focal aware seizures were more common in AE (14/21 vs. 6/25, p = 0.00058), whereas "isolated" focal-to-bilateral tonic-clonic seizures occurred in 5/25 patients with LOEUO only (p = 0.053). AE subjects reported ictal autonomic manifestations more frequently (p = 0.0033). Three-hundred-seventy and 24 seizures were recorded in 13/21 patients with AE and 3/25 patients with LOEUO, respectively (p = 0.0006). Interictal epileptiform discharges were observed in 70% of both groups, but their sleep activation was more common in AE (p = 0.06).ConclusionOur study shows that high-frequency focal seizures with autonomic manifestations should raise the suspicion of AE in the elderly with new-onset seizures. It also highlights the relevant contribution of AEEG, which might reduce the diagnostic delay and provide useful clues to recognize AE.
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