Cerebrospinal Fluid and Serum Autoantıbodıes in Drug-Resistant Temporal Lobe Epilepsıes: Case Series

Öz

We aimed to investigate the presence of neuronal antibodies in serum and cerebrospinal fluid(CSF) analysis of patients with drug resistant temporal lobe epilepsy. We evaluated 8 patients who accepted lumbar puncture with a diagnosis of drug resistant temporal lobe epilepsy. Neuronal autoantibodies were found to be negative in both serum and CSF in all patients. We investigated neuronal antibodies and clinical features in cases who were followed up for drug-resistant temporal lobe epilepsy and suspected of autoimmune epilepsy. Although neuronal antibodies were not detected in CSF and serum examinations, this may be related to the early age of onset in our study group. Autoimmune epilepsy should be considered among the differantial diagnosis with a subacute clinic, unusually high seizure frequency, variety and variability of seizures, resistance to antiseizure medications(ASMs), presence of an autoimmune disease in the person or his/her family, history of cancer or viral prodroma, demonstration of CNS inflammation and detection of neural antibodies.

Anahtar Kelimeler

• Temporal lobe epilepsy
• cerebrospinal fluid neuronal antibody,
• serum neuronal antibody,

Tedaviye Dirençli Temporal Lob Epilepsili Olgularda Serum ve Bos’ta Otoantikorlar: Olgu Serisi

Öz

Nöbet önleyici ilaca(NÖİ) dirençli temporal lob epilepsili hastaların serum ve beyin omurilik sıvısı (BOS) analizinde nöronal antikor varlığını araştırmayı amaçladık. İlaca dirençli temporal lob epilepsisi tanısı ile izlenen, lomber ponksiyonu kabul eden 8 hastayı değerlendirdik. İlaca dirençli temporal lob epilepsisi nedeniyle takip ettiğimiz ve otoimmün epilepsi şüphesi duyduğumuz olgularda nöronal antikorları ve klinik özellikleri araştırdık. Tüm hastalarda hem serum hem de BOS'ta nöronal otoantikorlar negatif bulundu. BOS ve serum incelemelerinde nöronal antikorlar saptanmasa da bu durum çalışma grubumuzda epilepsi başlangıç yaşının erken olması ile ilişkili olabilir. Subakut bir klinik, nöbet sıklığının alışılmadık derecede yüksek olması, nöbetlerin çeşitliliği ve değişkenliği, NÖİ’lara direnç, kişide veya ailesinde otoimmün hastalık varlığı, kanser öyküsü veya viral prodrom varlığı, santral sinir sistemi inflamasyonun gösterilmesi, nöral antikorların varlığında Otoimmün epilepsi ayırıcı tanıda düşünülmelidir.

Anahtar Kelimeler

• Temporal lob epilepsisi;
• beyin omurilik sıvısı nöronal antikoru
• serum nöronal antikor

Kaynakça

1. Quek AM, Britton JW, McKeon A, So E, Lennon VA, Shin C, et al. Autoimmune epilepsy: clinical characteristics and response to immunotherapy. Arch Neurol. 2012;69(5):582-93.
2. Vincent A, Irani SR, Lang B. The growing recognition of immunotherapy-responsive seizure disorders with autoantibodies to specific neuronal proteins. Curr Opin Neurol 2010;23(2):144-50.
3. Liimatainen S, Peltola M, Sabater L, Fallah M, Kharazmi E, Haapala AM, et al. Clinical significance of glutamic acid decarboxylase antibodies in patients with epilepsy. Epilepsia. 2010;51(5):760-7.
4. Höftberger R, van Sonderen A, Leypoldt F, Houghton D, Geschwind M, Gelfand J, et al. Encephalitis and AMPA receptor antibodies: novel findings in a case series of 22 patients. Neurology. 2015;84(24):2403-12.
5. Toledano M, Britton J, McKeon A, Shin C, Lennon VA, Quek A, et al. Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy. Neurology. 2014;82(18):1578-86.
6. Brenner T, Sills GJ, Hart Y, Howell S, Waters P, Brodie MJ, et al. Prevalence of neurologic autoantibodies in cohorts of patients with new and established epilepsy. Epilepsia. 2013;54(6):1028-35.
7. Irani SR, Bien CG, Lang B. Autoimmune epilepsies. Curr Opin Neurol. 2011;24(2):146-53.
8. Vanli-Yavuz EN, Erdag E, Tuzun E, Ekizoglu E, Baysal-Kirac L, Ulusoy C, et al. Neuronal autoantibodies in mesial temporal lobe epilepsy with hippocampal sclerosis. J Neurol Neurosurg Psychiatry 2016;87(7):684-92.

9. Majoie HM, de Baets M, Renier W, Lang B, Vincent AJEr. Antibodies to voltage-gated potassium and calcium channels in epilepsy. Epilepsy Res. 2006;71(2-3):135-41.
10. Bien CG, Bien CI, Onugoren M, De Simoni D, Eigler V, Haensch CA, et al. Routine diagnostics for neural antibodies, clinical correlates, treatment and functional outcome. J Neurol. 2020.
11. Elisak M, Krysl D, Hanzalova J, Volna K, Bien CG, Leypoldt F, et al. The prevalence of neural antibodies in temporal lobe epilepsy and the clinical characteristics of seropositive patients. Seizure. 2018;63:1-6.
12. Viaccoz A, Desestret V, Ducray F, Picard G, Cavillon G, Rogemond V, et al. Clinical specificities of adult male patients with NMDA receptor antibodies encephalitis. Neurology. 2014;82(7):556-63.
13. Lancaster E, Lai M, Peng X, Hughes E, Constantinescu R, Raizer J, et al. Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol. 2010;9(1):67-76.
14. Ekizoglu E, Tuzun E, Woodhall M, Lang B, Jacobson L, Icoz S, et al. Investigation of neuronal autoantibodies in two different focal epilepsy syndromes. Epilepsia. 2014;55(3):414-22.
15. Nóbrega‐Jr AW, Gregory CP, Schlindwein‐Zanini R, Neves FdS, Wolf P, Walz R, et al. Mesial temporal lobe epilepsy with hippocampal sclerosis is infrequently associated with neuronal autoantibodies. Epilepsia. 2018;59(9):e152-e6.