Exploration Of Clinical Features Of Immune Etiology Of Seizures And Epilepsy Assisted Interpretation

Purpose:To analyze the clinical characteristics of patients with unexplained epileptic seizure and epilepsy and to explore the characteristics associated with anti-neuronal antibody positivity as an aid in the interpretation of immune etiology,and to assess the utility of the APE2 score in detecting immune etiology in patients with seizures,with a view to improving clinician’s understanding of immune-related epilepsy and epileptic seizures and the use of adjunctive models for early identification of immune etiology to avoid delays in treatment.Method:Case data of all patients receiving cerebrospinal fluid(CSF)and/or serum sent for neuronal antibodies China-Japan Union Hospital of Jilin University between January2018 and November 2022 were collected to further screen patients with unexplained epilepsy and rapidly progressive epileptic seizures with or without rapidly progressive other neurological symptoms at the time of admission,after excluding definite infectious,metabolic,structural genetic cases,complete clinical features were recorded for the remaining cases.The included valid cases were divided into anti-neuronal antibody positive and negative groups and explored by using SPSS 26.0 software with chi-square test,Fisher’s exact probability method,continuous corrected chi-square test,Mann-Whitney U test and binary logistic for comparison of clinical manifestations and biochemical and imaging indices and immunotherapy responses associated with neuronal autoantibody features and to assess the applicability of the APE2 score.Where P < 0.050 was considered statistically significant.Results:A total of 82 cases were included.Of these,39 cases(47.56%)were positive for anti-neuronal antibodies and 43 cases(52.44%)were negative for anti-neuronal antibodies.When comparing the clinical characteristics between patients with positive and negative anti-neuronal antibodies,the following characteristics were positively associated with positive antibodies: advanced age,acute or subacute onset,concomitant tumor,rapidly progressive epileptic seizures,concomitant prodromal symptoms,concomitant psychobehavioural abnormalities,concomitant cognitive dysfunction,presence of impaired consciousness on admission,≥2 types of seizures,MRI of the head suggestive of inflammatory or demyelinating changes and multifocal inflammatory changes,CSF suggestive of inflammatory changes,increased protein content and increased WBC(P < 0.050).Binary logistic analysis comparing the clinical characteristics between patients with positive and negative anti-neuronal antibodies showed a positive correlation between combined tumors,CSF suggestive of inflammatory changes and MRI suggestive of inflammatory or demyelinating changes and positive neuronal antibodies(P < 0.050).In terms of neuronal antibody distribution,anti-neuronal surface and anti-intracellular antibodies were predominant in epileptic seizures and anti-GAD65-Ab in epilepsy.Of the 36 anti-neuronal antibody positive patients who initiated immunotherapy,28 cases(77.77%)responded well to immunotherapy and 8 cases(22.22%)responded poorly to immunotherapy.8 cases(19.51%)of the neuronal antibody negative patients received immunotherapy and all 8cases(100%)benefited from immunotherapy.An APE2 score was assigned to all patients,comparing the proportion of APE2 ≥ 4 scores between anti-neuronal antibody positive and negative patients,with APE2 ≥ 4 scores being more prevalent and higher in the positive group(p < 0.050).In the epilepsy and epileptic seizure population,APE2≥ 4 scores were more likely to be found in the epileptic seizure population.The sensitivity of using an APE2 ≥ 4 score as a screening tool for antibody testing in people with unexplained epilepsy and epileptic seizures was 82.05% and the specificity was79.07%.Conclusion:1.Immune-mediated is an important cause of unexplained epilepsy and epileptic seizures,and patients who are negative for anti-neuronal antibodies cannot be completely excluded from an immunologic cause.2.Common clinical features of AE,such as older age,concomitant tumor,acute or subacute onset,concomitant viral prodromal symptoms,rapidly progressive epileptic seizures,concomitant psychobehavioural abnormalities,concomitant cognitive dysfunction,presence of impaired consciousness on admission,≥2 types of seizures,head MRI suggestive of inflammatory or demyelinating changes or acute multifocal changes,CSF suggestive of inflammatory changes(protein content and increased WBC)can be used as early warning factors for immunologic etiology in patients with unexplained seizures,with CSF suggestive of inflammatory changes and MRI suggestive of inflammatory or demyelinating changes being independent predictors in patients with unexplained epilepsy and epileptic seizures.3.In unexplained epilepsy and epileptic seizures,the APE2 score can be used as an aid in the early assessment of immunologic etiology.