Factors related to possible autoimmune etiology in patients with drug-resistant epilepsy

Abstract

SUMMARY Background Between 14% and 20% of cases of drug-resistant epilepsy may be attributed to an impaired cellular or humoral immune response. Aim Our study aimed to assess disorders of the immune response of the humoral or cellular type and their impact on the course of the disease, factors suggesting the diagnosis of an autoimmune etiology. We wanted to analyse these factors, looking for correlations with a history of status epilepticus. Materials and methods This study prospectively analysed 30 patients who were diagnosed with drug-resistant epilepsy. The patients were divided into two groups: those who had previously experienced status epilepticus and those who had not. The study collected and analysed detailed information about the patient’s medical history, routine blood laboratory tests, albumin and immunoglobulin (IgG) levels, neuropsychological evaluations, electroencephalography tests (EEG), general cerebrospinal fluid (CSF) examinations, tests for the presence of oligoclonal bands, IgG index determination, MRZ-reaction (MRZR), chitotriosidase activity, and the presence of anti-herpes type 1 (anti-HSV-1) antibodies and neural autoantibodies. Each patient underwent magnetic resonance imaging (MRI) of the head with intravenous contrast administration using the epileptic protocol. Results There was no statistically significant difference in age, gender, onset and disease duration up to the time of our study. None of the patients showed the presence of the tested antibodies against neuronal surface antigens and oligoclonal bands in the CSF. Conclusion Lack of antibodies against neuronal antigens does not necessarily rule out autoimmune epilepsy. The exact diagnostic criteria are still a subject of debate. A history of SE increases the risk of autoimmune epilepsy.