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Abstract Details

Evaluation of seizure treatment in anti-LGI1, anti-NMDAR, and anti-GABABbR encephalitis
Autoimmune Neurology
S11 - Autoimmune CNS Inflammatory Disorders: Clinical Advances (4:47 PM-4:58 PM)
008

Seizures occur frequent in autoimmune encephalitis (AIE). Seizures often seem unresponsive to AEDs, while responses to immunotherapy are good. Nevertheless, seizure freedom is not always achieved while using immunotherapy and AEDs are sometimes needed as well. However, it is unclear whether AEDs are safe in these patients, if they are effective, and what AEDs should be preferred.

To evaluate responses of seizures to immunotherapy and antiepileptic drugs (AEDs) in patients with anti-leucine-rich glioma-inactivated 1 (LGI1), anti-N-Methyl-D-Aspartate Receptor (NMDAR), and anti-Gamma-Aminobutyric-Acid-B Receptor (GABABR) encephalitis, and to describe the risk for chronic epilepsy.

Patients with new-onset seizures and anti-LGI1, anti- GABABR or anti-NMDAR encephalitis were included in this nationwide cohort study. Medical information about disease course, types of AEDs and immunotherapies used, effects and side-effects were collected. Outcome measures were: 1) seizure freedom achieved while using AEDs, and while using immunotherapy, 2) days to seizure freedom from start of AEDs and from start of immunotherapy, 3) development of chronic epilepsy, and 4) reported side effects.

Of 153 AIE patients (53 LGI1; 75 NMDAR; 25 GABABR), 72% (n=110) had epilepsy, and 89% reached seizure freedom. At least 53% reached seizure freedom shortly after immunotherapy, and 14% achieved seizure freedom while using only AEDs (p<0.0001). Median time to seizure freedom from AEDs start was 59 days (IQR 27-160), and 28 days from start of immunotherapy (IQR 9-71, p<0.0001). Carbamazepine was more effective than levetiracetam in reducing seizures in anti-LGI1 encephalitis (p=0.031). Only one patient, of 86 surviving patients, developed chronic epilepsy.

Seizure freedom is achieved faster and more frequently after immunotherapy than after AEDs in patients with anti-LGI1, anti-NMDAR, and anti-GABABR encephalitis. AEDs should be considered as add-on therapy, and similar to treatment of other encephalitis symptoms, immunotherapy is most crucial. Chronic epilepsy is rare in adequately treated AIE.
Authors/Disclosures

PRESENTER
No disclosure on file
Agnes Van Sonderen No disclosure on file
No disclosure on file
Anna Bastiaansen Anna Bastiaansen has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Rinze F Neuteboom No disclosure on file
Peter Sillevis Smitt, MD (Erasmus MC) The institution of Dr. Sillevis Smitt has received research support from Euroimmun. Dr. Sillevis Smitt has received intellectual property interests from a discovery or technology relating to health care.
Roland Thijs No disclosure on file
Maarten J. Titulaer, MD, PhD (Erasmus Medical Center) The institution of Dr. Titulaer has received research support from Dutch Epilepsy Foundations (NEF 19-08). The institution of Dr. Titulaer has received research support from CSL Behring. The institution of Dr. Titulaer has received research support from UCB. The institution of Dr. Titulaer has received research support from Netherlands Organisation for Scientific Research (ZonMW, Memorabel initiative and E-RARE UltraAIE) . The institution of Dr. Titulaer has received research support from Horizon Therapeutics / Amgen. The institution of Dr. Titulaer has received research support from Dioraphte (charity). The institution of Dr. Titulaer has received research support from Guidepoint Global LLC. The institution of Dr. Titulaer has received research support from ArgenX. Dr. Titulaer has received publishing royalties from a publication relating to health care.