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01-03-2016 | Original Communication

Neuronal autoantibodies in epilepsy patients with peri-ictal autonomic findings

Authors: Leyla Baysal-Kirac, Erdem Tuzun, Ece Erdag, Canan Ulusoy, Ebru Nur Vanli-Yavuz, Esme Ekizoglu, Sian Peach, Mine Sezgin, Nerses Bebek, Candan Gurses, Aysen Gokyigit, Angela Vincent, Betul Baykan

Published in: Journal of Neurology | Issue 3/2016

Abstract

Autonomic dysfunction has frequently been reported in autoimmune encephalitis associated with seizures and there is growing evidence that epilepsy patients may display neuronal autoantibodies (NAAb). The aim of this study was to investigate the frequency of NAAb in epilepsy patients with peri-ictal autonomic findings. Fifty-eight patients (37 women/21 men; average age of 34.2 ± 9.9 years and epilepsy duration of 19.1 ± 9.6 years) who had at least one video-EEG recorded focal or secondary generalized seizure with clear-cut documented peri-ictal autonomic findings, or consistently reported seizures with autonomic semiology, were included. NAAb were tested by RIA or cell based assays. NAAb were present in 17 of 58 (29.3 %) patients. Among seropositive patients, antibodies were directed against N-methyl-d-aspartate receptor (NMDAR) in 5 (29 %), contactin-associated protein-like 2 (CASPR2) in 5 (29 %), uncharacterized voltage gated potassium channel (VGKC)-complex antigens in 3 (18 %), glutamic acid decarboxylase (GAD) in 2 (12 %), glycine receptor (GLYR) in one (6 %) and type A gamma aminobutyric acid receptor (GABA_AR) in one patient (6 %). Peri-ictal gastrointestinal manifestations, piloerection, ictal fever, urinary urge, and cough occurred more commonly in the seropositive group. The prevalences of psychotic attacks and status epilepticus were significantly increased in the seropositive group. Seropositivity prevalence in our patient group with peri-ictal autonomic findings is higher than other previously reported epilepsy cohorts. In our study, ictal fever-VGKC-complex antibody and pilomotor seizure-GABA_AR antibody associations were documented for the first time. Chronic epilepsy patients with peri-ictal autonomic semiology, history of status epilepticus and psychotic disorder may benefit from autoantibody screening.

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Title: Neuronal autoantibodies in epilepsy patients with peri-ictal autonomic findings
Authors: Leyla Baysal-Kirac
Erdem Tuzun
Ece Erdag
Canan Ulusoy
Ebru Nur Vanli-Yavuz
Esme Ekizoglu
Sian Peach
Mine Sezgin
Nerses Bebek
Candan Gurses
Aysen Gokyigit
Angela Vincent
Betul Baykan
Publication date: 01-03-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 3/2016
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-015-8002-2

At a glance: The STEP trials

Springer Medicine

Neuronal autoantibodies in epilepsy patients with peri-ictal autonomic findings

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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