Prevalence of Neural Autoantibodies in Paired Serum and Cerebrospinal Fluid in Adult Patients with Drug-Resistant Temporal Lobe Epilepsy of Unknown Etiology.
Pablo Cabezudo-García, Nicolás L Ciano-Petersen, Natalia Mena-Vázquez, Jesús Ortega-Pinazo, María J Postigo-Pozo, Guillermina García-Martín, Helena Antolí-Martínez, Violeta Sánchez-Sánchez, Pablo Quiroga-Subirana, Pedro J Serrano-Castro, Guillermo Estivill-Torrús
Author Information
Pablo Cabezudo-García: Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain. ORCID
Nicolás L Ciano-Petersen: Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain. ORCID
Natalia Mena-Vázquez: Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain. ORCID
Jesús Ortega-Pinazo: Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain.
María J Postigo-Pozo: Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain.
Guillermina García-Martín: Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain. ORCID
Helena Antolí-Martínez: Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain.
Violeta Sánchez-Sánchez: Neurology and Neurophysiology Unit, University Hospital Virgen Macarena, 41009 Sevilla, Spain.
Pablo Quiroga-Subirana: Neurology Unit, Hospitalary Complex Torrecárdenas, 04009 Almería, Spain. ORCID
Pedro J Serrano-Castro: Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain. ORCID
Guillermo Estivill-Torrús: Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain. ORCID
In order to determine the prevalence of neural autoantibodies in adult patients with drug-resistant temporal lobe epilepsy (DRTLE) of unknown etiology, we compared the characteristics of patients with and without autoantibodies and applied antibody predictive scores to the patients. Patients aged ≥18 years with DRTLE of unknown etiology and ≥12 months of evolution were prospectively recruited. Neural autoantibodies in serum and CSF were systematically determined in all patients. We created the ARTE (antibody in drug-resistant temporal lobe epilepsy) score based on the variables associated with the presence of neural autoantibodies. Twenty-seven patients were included. The mean (SD) age in years at the index date was 52 (±14.2) and at epilepsy onset was 32 (±17.1). The mean epilepsy duration was 19 (±12.5) years. Neural autoantibodies were detected in 51.85% (14/27) of patients. The presence of bitemporal, independent, interictal epileptiform discharges (BIIED) had a higher frequency in patients with neural autoantibodies (57.1% vs. 15.4%; = 0.025) as well as those patients with a previous history of status epilepticus (49.2% vs. 0.0%; = 0.007). The ARTE score showed an area under the curve (AUC) of 0.854. Using a cut-off point of ≥1, the sensitivity was 100% and the specificity was 46.1%, whereas when using a cut-off point of ≥3, the results were 35.7% and 100%, respectively. We found a high prevalence of neural autoantibodies in patients with DRTLE of unknown etiology, indicating an autoimmune mechanism. The presence of BIIED and a history of SE in DRTLE of unknown etiology are possible markers for autoimmune-associated epilepsy. The proposed ARTE score requires future validation in larger independent cohorts.
