Anna Rada, Anne Hagemann, Charlotte Aaberg Poulsen, Tobias Baumgartner, Timea Berki, Morten Blaabjerg, Juliette Brenner, Jeffrey W Britton, Andrew Christiana, Nicolás L Ciano-Petersen, Yvette Crijnen, Martin Elišák, Antonio Farina, Alec R Friedman, Zsófia Hayden, Julien Hébert, Martin Holtkamp, Zhen Hong, Jerome Honnorat, Maria Ilyas-Feldmann, Sarosh R Irani, Stjepana Kovac, Petr Marusic, Sergio Muñiz-Castrillo, Sudarshini Ramanathan, Kelsey M Smith, Claude Steriade, Christine Strippel, Rainer Surges, Maarten J Titulaer, Christopher E Uy, Juna M de Vries, Christian G Bien, Ulrich Specht
{"title":"NMDAR、LGI1、CASPR2 和 GABABR 抗体自身免疫性脑炎导致癫痫复发的风险：恢复驾驶的意义。","authors":"Anna Rada, Anne Hagemann, Charlotte Aaberg Poulsen, Tobias Baumgartner, Timea Berki, Morten Blaabjerg, Juliette Brenner, Jeffrey W Britton, Andrew Christiana, Nicolás L Ciano-Petersen, Yvette Crijnen, Martin Elišák, Antonio Farina, Alec R Friedman, Zsófia Hayden, Julien Hébert, Martin Holtkamp, Zhen Hong, Jerome Honnorat, Maria Ilyas-Feldmann, Sarosh R Irani, Stjepana Kovac, Petr Marusic, Sergio Muñiz-Castrillo, Sudarshini Ramanathan, Kelsey M Smith, Claude Steriade, Christine Strippel, Rainer Surges, Maarten J Titulaer, Christopher E Uy, Juna M de Vries, Christian G Bien, Ulrich Specht","doi":"10.1212/NXI.0000000000200225","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABA<sub>B</sub>R). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABA<sub>B</sub>R-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models.</p><p><strong>Results: </strong>We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABA<sub>B</sub>R-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85-0.92) for NMDAR, 0.84 (CI 0.80-0.88) for LGI1, 0.82 (CI 0.75-0.90) for CASPR2, and 0.76 (CI 0.62-0.93) for GABA<sub>B</sub>R.</p><p><strong>Discussion: </strong>Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.</p>","PeriodicalId":19472,"journal":{"name":"Neurology® Neuroimmunology & Neuroinflammation","volume":"11 4","pages":"e200225"},"PeriodicalIF":7.8000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11160480/pdf/","citationCount":"0","resultStr":"{\"title\":\"Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABA<sub>B</sub>R Antibodies: Implications for Return to Driving.\",\"authors\":\"Anna Rada, Anne Hagemann, Charlotte Aaberg Poulsen, Tobias Baumgartner, Timea Berki, Morten Blaabjerg, Juliette Brenner, Jeffrey W Britton, Andrew Christiana, Nicolás L Ciano-Petersen, Yvette Crijnen, Martin Elišák, Antonio Farina, Alec R Friedman, Zsófia Hayden, Julien Hébert, Martin Holtkamp, Zhen Hong, Jerome Honnorat, Maria Ilyas-Feldmann, Sarosh R Irani, Stjepana Kovac, Petr Marusic, Sergio Muñiz-Castrillo, Sudarshini Ramanathan, Kelsey M Smith, Claude Steriade, Christine Strippel, Rainer Surges, Maarten J Titulaer, Christopher E Uy, Juna M de Vries, Christian G Bien, Ulrich Specht\",\"doi\":\"10.1212/NXI.0000000000200225\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABA<sub>B</sub>R). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABA<sub>B</sub>R-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models.</p><p><strong>Results: </strong>We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABA<sub>B</sub>R-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85-0.92) for NMDAR, 0.84 (CI 0.80-0.88) for LGI1, 0.82 (CI 0.75-0.90) for CASPR2, and 0.76 (CI 0.62-0.93) for GABA<sub>B</sub>R.</p><p><strong>Discussion: </strong>Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.</p>\",\"PeriodicalId\":19472,\"journal\":{\"name\":\"Neurology® Neuroimmunology & Neuroinflammation\",\"volume\":\"11 4\",\"pages\":\"e200225\"},\"PeriodicalIF\":7.8000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11160480/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurology® Neuroimmunology & Neuroinflammation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1212/NXI.0000000000200225\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/4 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology® Neuroimmunology & Neuroinflammation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1212/NXI.0000000000200225","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/4 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABABR Antibodies: Implications for Return to Driving.
Background and objectives: Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABABR). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries.
Methods: This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABABR-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models.
Results: We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABABR-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85-0.92) for NMDAR, 0.84 (CI 0.80-0.88) for LGI1, 0.82 (CI 0.75-0.90) for CASPR2, and 0.76 (CI 0.62-0.93) for GABABR.
Discussion: Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.
期刊介绍：
Neurology Neuroimmunology & Neuroinflammation is an official journal of the American Academy of Neurology. Neurology: Neuroimmunology & Neuroinflammation will be the premier peer-reviewed journal in neuroimmunology and neuroinflammation. This journal publishes rigorously peer-reviewed open-access reports of original research and in-depth reviews of topics in neuroimmunology & neuroinflammation, affecting the full range of neurologic diseases including (but not limited to) Alzheimer's disease, Parkinson's disease, ALS, tauopathy, and stroke; multiple sclerosis and NMO; inflammatory peripheral nerve and muscle disease, Guillain-Barré and myasthenia gravis; nervous system infection; paraneoplastic syndromes, noninfectious encephalitides and other antibody-mediated disorders; and psychiatric and neurodevelopmental disorders. Clinical trials, instructive case reports, and small case series will also be featured.
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