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3. Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABA B R Antibodies

Author

Rada, Anna, primary, Hagemann, Anne, additional, Aaberg Poulsen, Charlotte, additional, Baumgartner, Tobias, additional, Berki, Timea, additional, Blaabjerg, Morten, additional, Brenner, Juliette, additional, Britton, Jeffrey W., additional, Christiana, Andrew, additional, Ciano-Petersen, Nicolás L., additional, Crijnen, Yvette, additional, Elišák, Martin, additional, Farina, Antonio, additional, Friedman, Alec R., additional, Hayden, Zsófia, additional, Hébert, Julien, additional, Holtkamp, Martin, additional, Hong, Zhen, additional, Honnorat, Jerome, additional, Ilyas-Feldmann, Maria, additional, Irani, Sarosh R., additional, Kovac, Stjepana, additional, Marusic, Petr, additional, Muñiz-Castrillo, Sergio, additional, Ramanathan, Sudarshini, additional, Smith, Kelsey M., additional, Steriade, Claude, additional, Strippel, Christine, additional, Surges, Rainer, additional, Titulaer, Maarten J., additional, Uy, Christopher E., additional, de Vries, Juna M., additional, Bien, Christian G., additional, and Specht, Ulrich, additional

Published
2024
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4. Seizure-Related Falls and Near Falls in LGI1-IgG Autoimmune Encephalitis

Author

Li, Xiaoyang, primary, Gupta, Pranjal, additional, Smith, Kelsey M., additional, Madhavan, Ajay, additional, Rezk, Mohamed, additional, Zekeridou, Anastasia, additional, Flanagan, Eoin P., additional, McKeon, Andrew, additional, Pittock, Sean J., additional, Britton, Jeffrey W., additional, and Dubey, Divyanshu, additional

Published
2024
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5. Outcomes of surgical resection and vagus nerve stimulation in patients with medically refractory epilepsy and glutamic acid decarboxylase 65 antibody positivity.

Author

Zhao‐Fleming, Hannah H., Guo, Yong, Britton, Jeffrey W., Dubey, Divyanshu, and Smith, Kelsey M.

Subjects
VAGUS nerve stimulation, GLUTAMATE decarboxylase, SEIZURES (Medicine), SURGICAL excision, ANTIBODY titer, TEMPORAL lobectomy
Abstract

Epilepsy associated with high‐titer glutamic acid decarboxylase 65 (GAD65) IgG is often refractory to immunotherapies and antiseizure medication. This study sought to determine the efficacy of vagus nerve stimulation (VNS) and surgical resection in patients with drug‐resistant epilepsy associated with GAD65‐IgG. We retrospectively identified 15 patients with drug‐resistant epilepsy and high serum GAD65 antibody titers (>20 nmol·L−1) who underwent VNS implantation (n = 6), surgical resection (n = 7), or both (n = 2). A responder to VNS was defined as someone with a ≥50% reduction in seizure frequency, and a favorable surgical outcome was defined as Engel I–II. Of the eight patients who underwent VNS implantation, three (37.5%) were initially responders, but this was not sustained in two. Of the nine patients who underwent surgical resection, three (33.3%) had a favorable outcome; however, only one patient was seizure‐free at last follow‐up. Pathology was available in six patients, and only one had evidence of inflammation; this patient had seizure onset 1 year prior to surgery. Favorable seizure outcome correlated with older age at time of resective surgery, with a trend favoring later age of seizure onset. Taken together, surgical resection and VNS implantation may have limited efficacy in this patient population but can be considered in carefully selected cases. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABABR Antibodies:Implications for Return to Driving

Author

Rada, Anna, Hagemann, Anne, Aaberg Poulsen, Charlotte, Baumgartner, Tobias, Berki, Timea, Blaabjerg, Morten, Brenner, Juliette, Britton, Jeffrey W., Christiana, Andrew, Ciano-Petersen, Nicolás L., Crijnen, Yvette, Elišák, Martin, Farina, Antonio, Friedman, Alec R., Hayden, Zsófia, Hébert, Julien, Holtkamp, Martin, Hong, Zhen, Honnorat, Jerome, Ilyas-Feldmann, Maria, Irani, Sarosh R., Kovac, Stjepana, Marusic, Petr, Muñiz-Castrillo, Sergio, Ramanathan, Sudarshini, Smith, Kelsey M., Steriade, Claude, Strippel, Christine, Surges, Rainer, Titulaer, Maarten J., Uy, Christopher E., De Vries, Juna M., Bien, Christian G., Specht, Ulrich, Rada, Anna, Hagemann, Anne, Aaberg Poulsen, Charlotte, Baumgartner, Tobias, Berki, Timea, Blaabjerg, Morten, Brenner, Juliette, Britton, Jeffrey W., Christiana, Andrew, Ciano-Petersen, Nicolás L., Crijnen, Yvette, Elišák, Martin, Farina, Antonio, Friedman, Alec R., Hayden, Zsófia, Hébert, Julien, Holtkamp, Martin, Hong, Zhen, Honnorat, Jerome, Ilyas-Feldmann, Maria, Irani, Sarosh R., Kovac, Stjepana, Marusic, Petr, Muñiz-Castrillo, Sergio, Ramanathan, Sudarshini, Smith, Kelsey M., Steriade, Claude, Strippel, Christine, Surges, Rainer, Titulaer, Maarten J., Uy, Christopher E., De Vries, Juna M., Bien, Christian G., and Specht, Ulrich

Abstract

Background and Objectives:Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABABR). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries.Methods:This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABABR-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models.Results:We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABABR-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85-0.92) for NMDAR, 0.84 (CI 0.80-0.88) for LGI1, 0.82 (CI 0.75-0.90) for CASPR2, and 0.76 (CI 0.62-0.93) for GABABR.Discussion:Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.

Published
2024

8. Autoimmune-associated seizure disorders

Author

Smith, Kelsey M., Budhram, Adrian, Geis, Christian, Mckeon, Andrew, Steriade, Claude, Stredny, Coral M., Titulaer, Maarten J., Britton, Jeffrey W., Smith, Kelsey M., Budhram, Adrian, Geis, Christian, Mckeon, Andrew, Steriade, Claude, Stredny, Coral M., Titulaer, Maarten J., and Britton, Jeffrey W.

Abstract

With the discovery of an expanding number of neural autoantibodies, autoimmune etiologies of seizures have been increasingly recognized. Clinical phenotypes have been identified in association with specific underlying antibodies, allowing an earlier diagnosis. These phenotypes include faciobrachial dystonic seizures with LGI1 encephalitis, neuropsychiatric presentations associated with movement disorders and seizures in NMDA-receptor encephalitis, and chronic temporal lobe epilepsy in GAD65 neurologic autoimmunity. Prompt recognition of these disorders is important, as some of them are highly responsive to immunotherapy. The response to immunotherapy is highest in patients with encephalitis secondary to antibodies targeting cell surface synaptic antigens. However, the response is less effective in conditions involving antibodies binding intracellular antigens or in Rasmussen syndrome, which are predominantly mediated by cytotoxic T-cell processes that are associated with irreversible cellular destruction. Autoimmune encephalitides also may have a paraneoplastic etiology, further emphasizing the importance of recognizing these disorders. Finally, autoimmune processes and responses to novel immunotherapies have been reported in new-onset refractory status epilepticus (NORSE) and febrile infection-related epilepsy syndrome (FIRES), warranting their inclusion in any current review of autoimmune-associated seizure disorders.

Published
2024

13. Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABABR Antibodies: Implications for Return to Driving.

Author

Rada, Anna, Hagemann, Anne, Poulsen, Charlotte Aaberg, Baumgartner, Tobias, Berki, Timea, Blaabjerg, Morten, Brenner, Juliette, Britton, Jeffrey W., Christiana, Andrew, Ciano-Petersen, Nicolás L., Crijnen, Yvette, Elišák, Martin, Farina, Antonio, Friedman, Alec R., Hayden, Zsófia, Hébert, Julien, Holtkamp, Martin, Zhen Hong, Honnorat, Jerome, and Ilyas-Feldmann, Maria

Published
2024
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20. Bilateral independent periodic discharges are associated with electrographic seizures and poor outcome: A case-control study

Author

Osman, Gamaleldin, Rahangdale, Rahul, Britton, Jeffrey W., Gilmore, Emily J., Haider, Hiba Arif, Hantus, Stephen, Herlopian, Aline, Hocker, Sara E., Woo Lee, Jong, Legros, Benjamin, Mendoza, Michael, Punia, Vineet, Rampal, Nishi, Szaflarski, Jerzy P., Wallace, Adam D., Westover, M. Brandon, Hirsch, Lawrence J., and Gaspard, Nicolas

Published
2018
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22. Seizure characteristics and outcomes in patients with neurological conditions related to high‐risk paraneoplastic antibodies

Author

Smith, Kelsey M., primary, Britton, Jeffrey W., additional, Thakolwiboon, Smathorn, additional, Chia, Nicholas H., additional, Gupta, Pranjal, additional, Flanagan, Eoin P., additional, Zekeridou, Anastasia, additional, Lopez Chiriboga, Alfonso S., additional, Valencia Sanchez, Cristina, additional, McKeon, Andrew, additional, Pittock, Sean J., additional, and Dubey, Divyanshu, additional

Published
2023
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23. High density scalp EEG in frontal lobe epilepsy

Author

Feyissa, Anteneh M., Britton, Jeffrey W., Van Gompel, Jamie, Lagerlund, Terrance L., So, Elson, Wong-Kisiel, Lilly C., Cascino, Gregory C., Brinkman, Benjamin H., Nelson, Cindy L., Watson, Robert, and Worrell, Gregory A.

Published
2017
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26. Stereo-EEG localization of midline onset seizures on scalp EEG

Author

Smith, Kelsey M., primary, Starnes, Donnie K., additional, Brinkmann, Benjamin H., additional, So, Elson, additional, Cox, Benjamin C., additional, Marsh, W. Richard, additional, Van Gompel, Jamie J., additional, Wirrell, Elaine, additional, Britton, Jeffrey W., additional, Burkholder, David B., additional, and Wong-Kisiel, Lily C., additional

Published
2023
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28. Seizure control in women with epilepsy undergoing assisted reproductive technology.

Author

Abdulrazaq, Aisha A., Ainsworth, Alessandra J., Britton, Jeffrey W., Shenoy, Chandra C., Babayev, Samir N., Cascino, Gregory D., and Smith, Kelsey M.

Subjects
REPRODUCTIVE technology, TEMPORAL lobectomy, EPILEPSY, SEIZURES (Medicine), EMBRYO transfer, FERTILIZATION in vitro
Abstract

The objective of this study was to determine seizure control in women with epilepsy (WWE) undergoing assisted reproductive technology (ART). Through retrospective chart review, WWE undergoing ART were identified. Demographics and details regarding epilepsy type, seizure control, and ART procedures were extracted. Seizure frequency prior to and during ART were compared. We identified 12 WWE, who underwent 29 embryo transfers, resulting in 16 pregnancies and 10 live births. Nine women were seizure‐free at least 2 years before fertility treatment, including three with resolved epilepsy. Seven were on antiseizure medications throughout fertility treatment and pregnancy, with only one on polytherapy. Eleven (all with controlled epilepsy or epilepsy in remission) remained seizure‐free throughout fertility treatment. One woman with drug‐resistant epilepsy continued to have seizures throughout fertility treatment and pregnancy without an exacerbation of seizure frequency. There was no increased seizure frequency associated with fertility treatment and subsequent pregnancy in this small series of WWE. Although this study was statistically underpowered, our results provide some preliminary evidence that ART might not pose a threat to seizure control, but larger, confirmatory studies are necessary. [ABSTRACT FROM AUTHOR]

Published
2023
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44. LGI1 antibody encephalitis: acute treatment comparisons and outcome

Author

Rodriguez, Andrew, primary, Klein, C J, additional, Sechi, Elia, additional, Alden, Eva, additional, Basso, Michael R, additional, Pudumjee, Shehroo, additional, Pittock, Sean J, additional, McKeon, Andrew, additional, Britton, Jeffrey W, additional, Lopez-Chiriboga, A Sebastian, additional, Zekeridou, Anastasia, additional, Zalewski, Nicholas L, additional, Boeve, B F, additional, Day, Gregory S, additional, Gadoth, Avi, additional, Burkholder, David, additional, Toledano, Michel, additional, Dubey, Divyanshu, additional, and Flanagan, Eoin P, additional

Published
2021
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