自身免疫性癫痫入院诊断与免疫治疗转归的相关性

Association between admission diagnosis and immunotherapy outcome in patients with autoimmune epilepsy

目的:回顾分析各种抗体类型自身免疫性癫痫(autoimmune epilepsy,AE)的临床资料,探讨入院诊断对癫痫预后的影响。方法:收集2017年1月1日至2018年11月21日中南大学湘雅医院神经内科抗神经元抗体阳性的AE病例40例,根据入院诊断分为初诊AE组及初诊非AE组,对比两组一般资料、临床症状、脑脊液、脑电图、影像学检查等结果,分析入院诊断对两组患者癫痫预后的影响。结果:40例AE患者年龄为(33.23±16.41)岁,男女比例为1:1.11。初诊AE组(n=25)与初诊非AE组(n=15)在性别、年龄、抗体分布、症状学特征、脑脊液、影像学表现等方面的差异均无统计学意义(均P>0.05)。初诊非AE组患者抗体检测距初始症状天数显著长于初诊AE组(P<0.01)。初诊非AE组患者免疫治疗距初始症状天数显著长于初诊AE组(P<0.001),且初诊AE组的癫痫好转率显著高于初诊非AE组(P<0.05)。结论:AE患者的入院诊断与其免疫治疗转归相关,针对成年期新发癫痫或病因不明的癫痫应充分考虑AE的可能性,AE患者一旦确诊应尽早启用免疫治疗以改善其预后。

Objective: To evaluate the impact of admission diagnosis on seizure outcome in patients with autoimmune epilepsy (AE). Methods: We conducted a retrospective study on 40 AE patients at Department of Neurology, Xiangya Hospital,Central South University from Jan.1st,2017 to Nov.21st,2018.According to their admission diagnosis,these patients were further assigned into 2 groups: An AE diagnosed group and an AE undiagnosed group.Demographic data,clinical characteristics,cerebrospinal fluid (CSF),electroencephalogram,and brain imaging were compared between the 2 groups.Favorable seizure outcome was defined as >50% reduction of seizure frequency at the first follow-up.The impact of admission diagnosis on seizure outcome of AE patients was analyzed. Results: The ages of 40 AE patients were (33.23±16.41) years,comprising 19 males and 21 females. No significant difference was found between the AE diagnosed group and the AE undiagnosed group in gender,age,central nervous system-specific Ab profile,CSF,and brain imaging.Duration of symptom onset to Ab detection was significantly longer in the AE undiagnosed group than that in the AE diagnosed group (P<0.01).Duration of symptom onset to immunotherapy was also significantly longer in the AE undiagnosed group than that in the AE diagnosed group (P<0.001). There were more patients with favorable seizure outcome in the AE diagnosed group than the AE undiagnosed group (P<0.05). Conclusion: Admission diagnosis for patients with AE is associated with seizure outcome after immunotherapy.For adult-onset epilepsy or epilepsy with unknown etiology,the diagnosis of AE should be considered.Early diagnosis of AE and prompt initiation of immunosuppressive treatment are crucial to increase the likelihood of achieving favorable seizure outcome.