JNNP: Predicting the clinical characteristics of autoantibodies on the surface of neurons in patients with neo-epilepsy: the significance of immunotherapy

Neuronal surface-directed antibodies (nsabs) are considered pathogenic in patients with autoimmune encephalitis (AE).
AE is usually manifested as a significant seizure and neuropsychiast, with priority response to immunotherapy and anti-epileptic drugs (asm).
this prompted the introduction of "Immune E-Epilepsy" in the International Anti-Epilepsy Alliance (ILAE) Classification 2017.
the same nsab, in addition to the high levels of antibodies in glutamate degluease-65 (GAD65), high levels of antibodies were found in the serum of more isolated epilepsy patients without the core characteristics of encephalitis.
, the clinical, ethiologic and therapeutic correlations are not clear, but this is important for all neurologistes treating new epilepsy.
large-scale, forward-looking, real-world study of YDT epilepsy, this paper predicts that the form of AE will help identify the clinical characteristics that suggest the presence of nsab and ask whether these nsab tests should change the treatment of patients.
recruited serial adult patients (≥18) from the regular practice of two epilepsyologists at Oxford University Hospitals NHS Foundation Trust to be diagnosed with neo-eclampsia and had their first seizure in the previous 12 months.
obtain written informed consent and serum (ethical approval: Oxfordshire RECA 07/Q160X/28 and REC16/YH/0013). Clinical data collected at the onset of
(online supplement table 1) include detailed esomoric and survey results, quality of life of patients with epilepsy, hospital anxiety and depression scores, Addenbrooke cognitive examination (ACE) and improved Rankin score (mRS);
then identified 1 and 3 years of MRS from NSAB patients.
statistical analysis is performed in R (V.3.6.1).
use multi-factor analysis in FactoMineR for dimensional reduction, using missForest to enter up to 10% of the missing data.
"arm" for step-by-step linear modeling analysis.
use "DescTools" to calculate Wilson 95% CIs with continuous correction.
in 219 (10.5%) patients, serum NSAb was detected in candidate antigens and new autoigens (Table 1), including for glioma infestion-1 (LGI1), The frequencies of contact protein-related protein samples 2 (CASPR2), N-methyl-d-winterline (NMDAR) and γ-aminobutic acid A/B (GABAAR and GABABR) are approximately equal.
five other patients had antibodies to the surface of living neurons without identifying their own antigens.
in one patient, autoantibodies to anti-contact proteins 2, glycine-like and α-amino-3-hydroxyl-5-methyl-4-isopropylate (AMPAR) were found.
no antibodies were detected for the two-peptide-based peptide enzyme-like protein 6 (DPPX) and the high-titration GD65.
, 9 out of 23 NSAB patients were clinically diagnosed with AE.
, 196 non-NSAbs patients were clinically diagnosed with AE (p.lt;0.0001; Fisher precision test).
multi-factor analysis showed that patients had a high degree of heterogeneity, and the moderate aggregation of nonsteroidal anti-inflammatory drugs was mainly driven by clinical diagnosis of AE.
single-variable analysis found significant differences between 11 clinical parameters in nonsteroidal anti-inflammatory groups and non-steroidal anti-inflammatory groups: age (p=0.04), seizure erection (p=0.02), lesions MRI (p=0.04), self-reported mood disorder (p=0.007), ACE attention domain (p=0.01) ), total ACE score (p=0.04), QOLIE-31 rating (p=0.02), self-reported neuropsychiatric characteristics (p=0.03), epilepsy risk factors (p=0.05), cerebrospinal fluid (CSF; p=0.004) and edge system lesions (p=0.0002). The
multi-step regression model assigns weighted scores to six of them: age ≥54 years old, self-reported mood disorders, MRI edge system lesions, seizure erections, and ACE attention scores≥16 to 1.5, and epilepsy risk factors to -1.5.
probability of NSAb positive increases with the increase in scores (Spearman's ρ-0.99, p-lt;0.0001) and subject operating characteristics (ROC) analysis confirms that these characteristics strongly predict NSAb status (AUC) of 0.83; total score ≥0; sensitivity is 66.7%, specificity is 84.9%).
In contrast, the APE2 score performed poorly in predicting NSAb status (sensitivity 43.5%, specificity 79.1%, AUC=0.68), and more accurately predicted standard-defined adverse events, especially those related to NSAb (sensitivity 85.7%, specificity 78.8%, AUC=0.94).
that although there is no immunotherapy, patients with nonsteroidal anti-inflammatory drugs usually show good results.
a prospective study of 19 patients with YDT epilepsy, NSAb status was best predicted by a combination of clinical parameters that were very similar to those observed in AE.
half of patients with nonsteroidal anti-inflammatory drugs are diagnosed with AE, and about 30% meet the strict standards of AE.
in nonsteroidal anti-inflammatory drugs and more isolated types of epilepsy, almost all patients were treated with ASMs alone and were usually asymptomatic during long-term follow-up.
, these findings suggest that nonsteroidal anti-inflammatory drugs are tested in new epilepsy patients, but do not have adverse event characteristics and should not alter current clinical treatment.
our observations will help guide the common clinical dilemmas of new epilepsy patients detecting autoantibodies and subsequent immunotherapy.
, the data show that clinical esopes are critical in guiding the relevance of autoantibo results and provide data to address an outstanding issue in the recent ILAE Consensus Statement.
McGinty RN, Handel A, Moloney T, et al Clinical features who predict neuronal surface autoantibodies in new-onset focallepsy: accountings for immunotherapiesjournal of Neurology, Neurosurgery and Psimology Published Online First: 20 November 2020. doi: 10.1136/jnnp-2020-325011MedSci Original Source: MedSci Original Copyright Notice: All notes on this website "Source: Met Medical" or "Source: MedSci Original" text, pictures and audio and video materials, Copyright is owned by Mace Medical and may not be reproduced by any media, website or individual without authorization, with the following "Source: Met Medical" stated at the time of reprint.
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