Your browser doesn't support javascript.
loading
Antibody Prevalence in Epilepsy before Surgery (APES) in drug-resistant focal epilepsy.
Li, Yi; Tymchuk, Sarah; Barry, John; Muppidi, Srikanth; Le, Scheherazade.
Afiliación
  • Li Y; Stanford Comprehensive Epilepsy Center, Stanford University, Palo Alto, CA, USA.
  • Tymchuk S; Department of Psychiatry, University of Alberta Hospital, Alberta, Canada.
  • Barry J; Stanford Department of Psychiatry, Stanford University, Palo Alto, CA, USA.
  • Muppidi S; Stanford Department of Neurology, Stanford University, Palo Alto, CA, USA.
  • Le S; Stanford Comprehensive Epilepsy Center, Stanford University, Palo Alto, CA, USA.
Epilepsia ; 2021 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-33464599
ABSTRACT

OBJECTIVE:

There is a growing recognition of immune-mediated causes in patients with focal drug-resistant epilepsy (DRE); however, they are not systematically assessed in the pre-surgical diagnostic workup. Early diagnosis and initiation of immunotherapy is associated with a favorable outcome in immune-mediated seizures. Patients with refractory focal epilepsy with neuronal antibodies (Abs) tend to have a worse surgical prognosis when compared to other etiologies.

METHODS:

We studied the prevalence of serum Abs in patients ≥18 years of age with DRE of unknown cause before surgery. We proposed and calculated a clinical APES (Antibody Prevalence in Epilepsy before Surgery) score for each subject, which was modified based on Dubey's previously published APE2 score. RESULTS` A total of 335 patients were screened and 86 subjects were included in final analysis. The mean age at the time of recruitment was 44.84 ± 14.86 years, with age at seizure onset 30.89 ± 19.88 years. There were no significant differences among baseline clinical features between retrospective and prospective sub-cohorts. The prevalence of at least one positive Ab was 33.72%, and central nervous system (CNS)-specific Abs was 8.14%. APES score ≥4 showed slightly better overall prediction (area under the curve [AUC] 0.84 vs 0.74) and higher sensitivity (100% vs 71.4%), with slightly lower but similar specificity (44.3% vs 49.4%), when compared to APE2 score ≥4. For subjects who had available positron emission tomography (PET) results and all components of APES score (n = 60), the sensitivity of APES score ≥4 yielded a similar prediction potential with an AUC of 0.80.

SIGNIFICANCE:

Our findings provide persuasive evidence that a subset of patients with focal DRE have potentially immune-mediated causes. We propose an APES score to help identify patients who may benefit from a workup for immune etiologies during the pre-surgical evaluation for focal refractory epilepsy with unknown cause.
Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Tipo de estudio: Estudio de prevalencia / Estudio pronóstico / Factores de riesgo / Estudio de tamizaje Idioma: Inglés Año: 2021 Tipo del documento: Artículo País de afiliación: Estados Unidos

Similares

MEDLINE

...
LILACS

LIS

Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Tipo de estudio: Estudio de prevalencia / Estudio pronóstico / Factores de riesgo / Estudio de tamizaje Idioma: Inglés Año: 2021 Tipo del documento: Artículo País de afiliación: Estados Unidos