以癫痫发作为首发症状的自身免疫性脑炎8例临床分析

Clinical Analysis of Autoimmune Encephalitis with Seizure as First Symptom: 8 Cases Report

目的:分析以癫痫发作为首发症状的自身免疫性脑炎的临床资料。方法:回顾性分析以癫痫发作为首发症状的自身免疫性脑炎8例患者的临床表现、实验室检测结果、影像学检查、脑电图特点、治疗结果及随访记录,并结合文献讨论。结果:8例患者中,抗NMDAR脑炎5例,抗GABAR脑炎2例,抗LGI1脑炎1例;男6例,女2例;发病年龄18~66岁,平均50岁;均以癫痫发作为首发症状,均有反应迟钝、近记忆力下降的症状,其中出现精神行为异常3例,言语障碍1例,顽固性低钠血症1例;均有≥1种的癫痫发作形式,脑电图异常6例;头颅MRI检查异常4例。结论:对于以癫痫发作为首发症状的自身免疫性脑炎患者,早期免疫治疗及抗癫痫治疗,对于控制症状、改善预后具有重要意义。

Objective: To analyze the clinical data of autoimmune encephalitis with seizure as the first symptom. Methods: The clinical manifestations, laboratory test results, imaging examinations, electro-encephalogram (EEG) characteristics, treatment, and follow-up records of 8 autoimmune encephalitis cases with seizure as the first symptom were retrospectively reviewed and discussed in combination with literature. Results: Among the 8 cases, there were 5 cases with anti-NMDAR encephalitis, 2 cases with anti-GABAR encephalitis, and 1 case with anti-LGI1 encephalitis;there were 6 males and 2 females;the age of onset ranged from18 to 66 years old, with an average age of 50 years. All the patients experienced seizure as the first symptom and demonstrated slow response and short-term memory decline. Among them, 3 cases exhibited abnormal mental behavior, 1 exhibited speech disorder, and 1 exhibited refractory hyponatremia. All displayed seizure of one or more types. There were 6 cases with abnormal EEG and 4 cases with abnormal MRI. Conclusion: Early immunotherapy and anti-epileptic treatment are of great significance in controlling symptoms and improving prognosis for patients with autoimmune encephalitis with epilepsy as the first symptom.