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Cabezudo-García P, Ciano-Petersen NL, Mena-Vázquez N, Ortega-Pinazo J, Postigo-Pozo MJ, García-Martín G, Antolí-Martínez H, Sánchez-Sánchez V, Quiroga-Subirana P, Serrano-Castro PJ, Estivill-Torrús G. Prevalence of Neural Autoantibodies in Paired Serum and Cerebrospinal Fluid in Adult Patients with Drug-Resistant Temporal Lobe Epilepsy of Unknown Etiology. J Clin Med 2021; 10:jcm10214843. [PMID: 34768363 PMCID: PMC8584597 DOI: 10.3390/jcm10214843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 02/05/2023] Open
Abstract
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%; p = 0.025) as well as those patients with a previous history of status epilepticus (49.2% vs. 0.0%; p = 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.
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Affiliation(s)
- Pablo Cabezudo-García
- Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain; (P.C.-G.); (N.L.C.-P.); (N.M.-V.); (J.O.-P.); (M.J.P.-P.); (G.G.-M.); (H.A.-M.); (G.E.-T.)
- Neurosciences Clinical Unit, University Regional Hospital of Málaga, 29010 Málaga, Spain
- School of Medicine, University of Málaga, 29010 Málaga, Spain
| | - Nicolás L. Ciano-Petersen
- Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain; (P.C.-G.); (N.L.C.-P.); (N.M.-V.); (J.O.-P.); (M.J.P.-P.); (G.G.-M.); (H.A.-M.); (G.E.-T.)
- Neurosciences Clinical Unit, University Regional Hospital of Málaga, 29010 Málaga, Spain
| | - Natalia Mena-Vázquez
- Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain; (P.C.-G.); (N.L.C.-P.); (N.M.-V.); (J.O.-P.); (M.J.P.-P.); (G.G.-M.); (H.A.-M.); (G.E.-T.)
- Rheumatology Clinical Unit, University Regional Hospital of Málaga, 29009 Málaga, Spain
| | - Jesús Ortega-Pinazo
- Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain; (P.C.-G.); (N.L.C.-P.); (N.M.-V.); (J.O.-P.); (M.J.P.-P.); (G.G.-M.); (H.A.-M.); (G.E.-T.)
| | - María J. Postigo-Pozo
- Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain; (P.C.-G.); (N.L.C.-P.); (N.M.-V.); (J.O.-P.); (M.J.P.-P.); (G.G.-M.); (H.A.-M.); (G.E.-T.)
- Neurosciences Clinical Unit, University Regional Hospital of Málaga, 29010 Málaga, Spain
| | - Guillermina García-Martín
- Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain; (P.C.-G.); (N.L.C.-P.); (N.M.-V.); (J.O.-P.); (M.J.P.-P.); (G.G.-M.); (H.A.-M.); (G.E.-T.)
- Neurosciences Clinical Unit, University Regional Hospital of Málaga, 29010 Málaga, Spain
| | - Helena Antolí-Martínez
- Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain; (P.C.-G.); (N.L.C.-P.); (N.M.-V.); (J.O.-P.); (M.J.P.-P.); (G.G.-M.); (H.A.-M.); (G.E.-T.)
- Neurosciences Clinical Unit, University Regional Hospital of Málaga, 29010 Málaga, Spain
| | - Violeta Sánchez-Sánchez
- Neurology and Neurophysiology Unit, University Hospital Virgen Macarena, 41009 Sevilla, Spain;
| | | | - Pedro J. Serrano-Castro
- Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain; (P.C.-G.); (N.L.C.-P.); (N.M.-V.); (J.O.-P.); (M.J.P.-P.); (G.G.-M.); (H.A.-M.); (G.E.-T.)
- Neurosciences Clinical Unit, University Regional Hospital of Málaga, 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-671562365; Fax: +34-951291135
| | - Guillermo Estivill-Torrús
- Biomedical Research Institute of Málaga-IBIMA, 29010 Málaga, Spain; (P.C.-G.); (N.L.C.-P.); (N.M.-V.); (J.O.-P.); (M.J.P.-P.); (G.G.-M.); (H.A.-M.); (G.E.-T.)
- Neurosciences Clinical Unit, University Regional Hospital of Málaga, 29010 Málaga, Spain
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