Clinical Approach to Autoimmune Epilepsy
10.3988/jcn.2020.16.4.519
- Author:
Yoonhyuk JANG
1
;
Dong Wook KIM
;
Kwang Ik YANG
;
Jung-Ick BYUN
;
Jong-Geun SEO
;
Young Joo NO
;
Kyung Wook KANG
;
Daeyoung KIM
;
Keun Tae KIM
;
Yong Won CHO
;
Soon-Tae LEE
;
Author Information
1. Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Publication Type:REVIEW
- From:Journal of Clinical Neurology
2020;16(4):519-529
- CountryRepublic of Korea
- Language:0
-
Abstract:
Autoimmune epilepsy is a newly emerging area of epilepsy. The concept of “autoimmune” as an etiology has recently been revisited thanks to advances in autoimmune encephalitis and precision medicine with immunotherapies. Autoimmune epilepsy presents with specific clinical manifestations, and various diagnostic approaches including cerebrospinal fluid analysis, neuroimaging, and autoantibody tests are essential for its differential diagnosis. The diagnosis is often indeterminate despite performing a thorough evaluation, and therefore empirical immunotherapy may be applied according to the judgment of the clinician. Autoimmune epilepsy often manifests as new-onset refractory status epilepticus (NORSE). A patient classified as NORSE should receive empirical immunotherapy as soon as possible. On the other hand, a morecautious, stepwise approach is recommended for autoimmune epilepsy that presents with episodic events. The type of autoimmune epilepsy is also an important factor to consider when choosing from among various immunotherapy options. Clinicians should additionally take the characteristics of antiepileptic drugs into account when using them as an adjuvant therapy. This expert opinion discusses the diagnostic and treatment approaches for autoimmune epilepsy from a practical point of view.
