Distinguishing seizures in autoimmune limbic encephalitis from mesial temporal lobe epilepsy with hippocampal sclerosis: Clues of a temporal plus network

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Journal of the Neurological Sciences Pub Date : 2024-11-04 DOI:10.1016/j.jns.2024.123288

Alessandra Morano , Emanuele Cerulli Irelli , Francesco Fortunato , Sara Casciato , Chiara Panzini , Chiara Milano , Salvatore Versace , Biagio Orlando , Raffaele Iorio , Emanuele Tinelli , Gabriele Ruffolo , Chiara Pizzanelli , Alberto Vogrig , Pierpaolo Quarato , Anna Teresa Giallonardo , Giancarlo Di Gennaro , Antonio Gambardella , Carlo Di Bonaventura

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引用次数: 0

Abstract

Objective

Diagnosing autoimmune limbic encephalitis (ALE) in adults with new-onset seizures can be challenging, especially when seizures represent the predominant manifestation and MRI findings are not straightforward. By comparison with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS), this study aimed to identify ictal electro-clinical features that might help clinicians recognize ALE-related seizures.

Methods

This retrospective, multi-centre study analysed the ictal semiology and EEG correlate of 116 video-EEG-captured seizures in 40 ALE patients and 45 ones recorded in 21 MTLE-HS subjects. The proportion of patients presenting each clinical feature on at least one occasion was compared between the study groups. Latent class analysis (LCA) was also performed.

Results

Ictal features were overall more numerous in ALE than in MTLE-HS (33 vs 22), and LCA confirmed the intrinsic variability of ALE-related seizures. Hyperventilation served as a trigger only in ALE (4/40). Awareness impairment (p = 0.032), limb dystonic posturing (p = 0.009) and manual automatisms (p < 0.001) were significantly less common in ALE cases. Conversely, piloerection was observed only in ALE subjects, although it did not reach statistical significance (p = 0.289), as was the case for déjà-vu (p = 0.084), and sensory symptoms (p = 0.079). Regarding EEG, the type of ictal pattern differed significantly (p = 0.007).

Significance

This study shows that, despite the wide overlap with MTLE-HS, some ictal electro-clinical features could help clinicians suspect the autoimmune origin of adult-onset seizures. Moreover, autoimmune limbic seizures apparently shared similarities with ‘temporal plus’ epilepsy, which could partly account for the poor surgical outcomes and provide an interesting conceptual framework for future research.

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区分自身免疫性肢端脑炎和伴有海马硬化症的颞叶癫痫发作：颞加网络的线索。

目的：在新发癫痫发作的成人中诊断自身免疫性肢端脑炎（ALE）可能具有挑战性，尤其是当癫痫发作为主要表现且核磁共振成像结果并不直观时。通过与伴有海马硬化症的颞叶间叶癫痫（MTLE-HS）进行比较，本研究旨在确定发作性电临床特征，以帮助临床医生识别与ALE相关的癫痫发作：这项多中心回顾性研究分析了40名ALE患者的116次视频-EEG捕获发作和21名MTLE-HS受试者的45次视频-EEG捕获发作的发作符号学和EEG相关性。研究人员比较了两组患者至少一次出现各临床特征的比例。研究还进行了潜类分析（LCA）：结果：与 MTLE-HS 相比，ALE 的直观特征总体上更多（33 对 22），LCA 证实了 ALE 相关性癫痫发作的内在可变性。过度换气仅是ALE的诱发因素（4/40）。意识障碍（p = 0.032）、肢体肌张力障碍姿势（p = 0.009）和手动自动症（p 意义重大：本研究表明，尽管与 MTLE-HS 有广泛的重叠，但某些发作性电临床特征可帮助临床医生怀疑成人癫痫发作源于自身免疫。此外，自身免疫性肢端癫痫发作显然与 "颞加性 "癫痫有相似之处，这可能是手术效果不佳的部分原因，并为今后的研究提供了一个有趣的概念框架。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the Neurological Sciences 医学-临床神经学

CiteScore

7.60

自引率

2.30%

发文量

313

审稿时长

22 days

期刊介绍： The Journal of the Neurological Sciences provides a medium for the prompt publication of original articles in neurology and neuroscience from around the world. JNS places special emphasis on articles that: 1) provide guidance to clinicians around the world (Best Practices, Global Neurology); 2) report cutting-edge science related to neurology (Basic and Translational Sciences); 3) educate readers about relevant and practical clinical outcomes in neurology (Outcomes Research); and 4) summarize or editorialize the current state of the literature (Reviews, Commentaries, and Editorials). JNS accepts most types of manuscripts for consideration including original research papers, short communications, reviews, book reviews, letters to the Editor, opinions and editorials. Topics considered will be from neurology-related fields that are of interest to practicing physicians around the world. Examples include neuromuscular diseases, demyelination, atrophies, dementia, neoplasms, infections, epilepsies, disturbances of consciousness, stroke and cerebral circulation, growth and development, plasticity and intermediary metabolism.