| خلاصه مقاله | Management of seizure related to Autoimmune encephalitis
Saeid Charsouei,MD,Associate Professor of Neurology,Epilepsy Fellowship
Neurology Department, Razi Hospital, Tabriz University of Medical Sciences
Seizures are a very common manifestation of autoimmune
encephalitis (AE), ranging from 33% to 100% depending on
the antigen.
In encephalitis with antibodies to neuronal extracellular antigens, autoantibodies play a direct role in disease pathogenesis. They
have access to target antigens and can potentially alter the
structure and function of antigens but induce relatively little
neuronal death.Prompt immunotherapy is usually very effective, and long-term antiepileptic treatment may not be needed.
In contrast, in encephalitis with antibodies against
intracellular antigens , autoantibodies may not be directly
pathogenic but serve as tumor markers. These autoantibodies cannot reach intracellular target antigens and are considered to result from a T-cell-mediated immune response against antigens released by apoptotic tumor cells, which
contain nerve tissue or express neuronal proteins. Neuronal
loss is frequently described and predominantly induced
through cytotoxic T-cell mechanisms. They often exhibit an
inadequate response to immunotherapy and require early
tumor treatment. Long-term antiepileptic treatment is usually needed.
Treatment for suspected autoimmune encephalitis is often
given empirically prior to specific antibody test results. This
may include steroids and/or IVIG. If a cell-surface/synaptic
antibody disorder is diagnosed, initial treatments may include IVIG, plasmapheresis, and/or steroids. |