15例自身免疫性癫痫的临床特征

Clinical features of 15 cases of autoimmune epilepsy

目的:分析自身免疫性癫痫(AE)患者的临床特点、诊治经过、癫痫自身免疫性抗体流行率(APE)评分及预后。方法:回顾性分析2016年1月至2019年1月武汉大学中南医院神经内科收治的15例AE患者,总结患者的临床表现、脑电图及影像学特征、血清及脑脊液自身免疫性抗体结果、诊治经过及预后,并对所有患者进行基于临床特点的APE评分。结果:共收集AE患者15例,其中抗NMDAR抗体相关AE 5例;抗LGI1抗体相关AE 1例;抗GABABR抗体阳性AE 3例;4例患者自身免疫性抗体阴性;1例患者血清自身免疫抗体阳性;1例患者拒查抗体。10例抗体阳性AE患者中脑脊液抗体阳性AE患者的APE评分均≥4分。15例患者经免疫治疗后癫痫症状明显控制。结论:对于常规抗癫痫药物难以控制的不明原因的癫痫患者,应考虑到AE可能。APE评分≥4分可能有助于指导临床进行自身免疫性抗体的筛查。

Objective:To analyze the clinical characteristics,diagnosis,treatment,antibody prevalence in epilepsy(APE)score,and prognosis of patients with autoimmune epilepsy(AE).Methods:We con-ducted a retrospective study on patients diagnosed as AE in Zhongnan Hospital of Wuhan University from January 2016 to January 2019.The clinical manifestations,electroencephalography and imaging characteristics,results of serum and cerebrospinal fluid(CSF)antibodies,diagnosis,treatment,and prognosis were summarized.All patients were assessed with APE score based on clinical features.Results:Fifteen cases of AE were collected,including 5 cases of anti-NMDAR antibody-related AE,1 case of anti-LGI1 antibody-related AE,3 cases of anti-GABABR antibody positive AE,4 cases of negative autoimmune antibody,1 case of serum positive autoantibody and 1 case without antibody de-tection.All the 10 cases with positive antibody,APE scores≥4 in CSF.The symptoms of epilepsy were controlled after immunotherapy in 15 patients.Conclusion:The possibility of AE should be con-sidered in patients with unexplained epilepsy,which is difficult to control by routine antiepileptic drugs.APE score≥4 may be helpful to guide clinical screening of autoimmune antibodies.