Clinical Characteristics Of Patients With Acute Epileptic Seizure Of Neuronal Surface Antibody Associated Encephalitis

Objective: To summarize the clinical characteristics,treatment and regression of patients with acute seizures in different neuronal cell surface antibody encephalitis for analysis and to analyze the manifestation of organismal injury in different types of neuronal cell surface antibody-related encephalitis.Methods: A retrospective analysis of56 patients with acute epileptic seizures of neuronal cell surface antibody associated encephalitis admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2016 to June 2022 was performed.Patients were divided into anti-neuronal surface synaptic protein receptor group and anti-neuronal surface ion channel protein receptor group according to the types of neuronal surface antibodies.The anti-neuronal surface synaptic protein receptor group included anti-Nmd AR encephalitis and anti-Gababr encephalitis.Anti-neuronal surface ion channel protein receptor group: including anti-Cas PR2 encephalitis,anti-LGI1 encephalitis.The general situation,clinical manifestations,auxiliary examination and other clinical data of the two groups of patients were described and compared.Results:(1)A total of 56 patients were included,among which anti-NMDAR encephalitis accounted for 37.5%(21/56),anti-Gababr encephalitis accounted for 25%(14/56),anti-Caspr2 encephalitis accounted for 21%(12/56),anti-LGI1 encephalitis accounted for 16%(9/56),and anti-NMDAR encephalitis was the most common.(2)Analysis of general and clinical data: there were no significant differences in gender,age,first symptom,seizure and duration,seizure type,incidence of focal seizure and general seizure between the two groups(P > 0.05).Gender: There were more male than female patients in the anti-neuronal surface synaptic protein receptor group.In the anti-neuronal surface ion channel protein receptor group,male and female patients were almost equal.Age: The median age of the anti-neuronal surface synaptic protein receptor group was lower than that of the anti-neuronal surface ion channel protein receptor group.First symptom: seizure was the most common first symptom between the two groups.Epileptic seizure characteristics: patients between the two groups were more likely to have seizures within 1 week of the course of disease.One type of seizure was most common in both groups.Overall tonic-clonic seizures were more common in both groups.Patients in the anti-neuronal surface synaptic protein receptor group had a higher risk of developing SE.In the anti-neuronal surface ion channel protein receptor group,33.33%(3/9)of anti-LGI1 antibody encephalitis showed FBDS.(3)Laboratory examination:There were statistically significant differences in the incidence of increased intracranial pressure,increased CSF white blood cells and hyponatremia between the two groups(P<0.05).There were no significant differences in serum and cerebrospinal fluid antibody detection results,elevated CSF protein,hypokalemia,elevated inflammatory factors and abnormal tumor markers between the two groups(P > 0.05).The incidence of only positive serum antibody,only positive CSF antibody,increased ICP,increased CSF leukocyte,hypokalemia,elevated inflammatory factors and abnormal tumor markers in the anti-neuronal surface synaptic protein receptor group was higher than that in the anti-neuronal surface ion channel protein receptor group.In the anti-neuronal surface ion channel protein receptor group,serum and cerebrospinal fluid antibodies were positive,CSF protein was elevated,and the incidence of hyponatremia was higher than that in the anti-neuronal surface ion channel protein receptor group.(4)Head MRI: The abnormal rate of head MRI in the anti-neuronal surface synaptic protein receptor group was higher than that in the anti-neuronal surface ion channel protein receptor group,and temporal lobe lesions were the most common lesions between the two groups.(5)Eeg: The rate of EEG abnormalities in the anti-neuronal surface ion channel protein receptor group was higher than that in the anti-neuronal surface synaptic protein receptor group.Diffuse slow activity was the most common background EEG abnormality in both groups.The temporal region was the most common origin of epileptic seizure in both groups.Conclusion:1.The onset age of patients in the anti-neuronal surface synaptic protein receptor group and anti-neuronal surface ion channel protein receptor group was mostly young adults aged18-50 years,and there was no significant gender or age difference.2.Patients in the anti-neuronal surface synaptic protein receptor group had a higher risk of epileptic state,abnormal ICP(increased)rate and abnormal CSF white blood cells(increased)rate.3.Patients in the anti-neuronal surface ion channel protein receptor group had a higher risk of hyponatremia.