Autoimmune epilepsy, retrospective case series of clinical features, management, and outcomes.

OBJECTIVES: To evaluate the clinical and electrographic features of patients with autoimmune epilepsy and assess the influence of early diagnosis and treatment on reducing seizure frequency. METHODS: A retrospective observational case series was conducted utilizing medical records from King Abdullah Medical Hospital between 2017 and 2022. Cases of newly diagnosed seizures were chosen based on laboratory-proven autoimmunity. RESULTS: Five female inpatients were identified, primarily presenting with seizures suggestive of an autoimmune origin. Autoimmune antibodies were detected in all patients as follows: GAD (3), NMDA-R (2). One patient exhibited unilateral temporal lobe onset while three displayed bilateral onset. One patient had an associated malignancy. Rituximab was administered as an immunomodulatory therapy to four patients, resulting in successful seizure reduction post-immunotherapy initiation. CONCLUSION: Autoimmune epilepsy is recognized as a distinct condition. The clinical presentation can be complex and antibody testing may warrant repetition if initial results are negative or if specific antibodies are not detected. Early initiation of immunosuppression, coupled with prompt treatment escalation when required, is vital for achieving optimal patient outcomes.

Localization of ictal Islamic rituals: Study of epilepsy center in Makkah.

BACKGROUND: Ictal semiology is important to aid the diagnosis of seizure type. Patients frequently require admission to an epilepsy monitoring unit (EMU) to reach a correct diagnosis of epilepsy type. Some patients may exhibit unusual ictal phenomena that can lead to the diagnosis of psychogenic seizures. Unusual ictal phenomena include ictal kissing, praying, and drinking. Ictal religious speech and praying are other examples of unusual ictal phenomena. This study aims to assess the localization value of ictal Islamic rituals. METHODS: We retrospectively reviewed all patients admitted to the EMU at King Abdullah Medical City in Makkah between 2017 and 2021. Patients with ictal Islamic rituals were included in the study. RESULTS: Nine out of the 279 cases admitted to the EMU have different ictal Islamic rituals. Some patients exhibited multiple Islamic rituals during their seizures. Six patients performed Islamic religious speech, including asking Allah to help, asking for forgiveness, and making basmala (in the name of Allah). Three patients exhibited self-immunization patterns (tahseen). Three patients repeatedly raised their right index fingers (shahada movements). All nine patients had seizures originating from the right temporal lobe. CONCLUSIONS: Islamic rituals are rare ictal phenomena localized to the right temporal lobe.