Neurology-LGI1-抗体脑炎者,行免疫治疗仍会出现慢性癫痫

2021-07-17 Freeman MedSci原创

LGI1-抗体脑炎者,行免疫治疗仍会出现慢性癫痫

靶向神经表面抗原的自身抗体已被越来越多地确定为脑炎和癫痫发作的一个原因。富含亮氨酸的胶质瘤灭活(leucine-rich glioma-inactivated 1,LGI1)抗体与边缘性脑炎和急性症状性癫痫发作(包括面肌张力障碍性发作(FBDS))有关,后者通常对抗癫痫药物治疗(ASM)耐受。

然而,在长期随访中,有高达35%的病人复发,而且在急性脑炎缓解后,也有慢性癫痫的报道。最近有几篇文章指出,由于针对神经细胞表面抗原(如LGI1)的抗体,脑炎患者出现了慢性癫痫的情况。在一项研究中,免疫治疗延迟和脑电图上出现发作性癫痫样放电被确定为与持续发作或复发有关的风险因素。然而,考虑到这种情况的相对罕见性和已发表的系列文章中的样本量小,可能存在这些次优结果的其他风险因素。此外,慢性类固醇疏散免疫疗法在治疗这种疾病方面的疗效还没有得到很多关注。

藉此, 布朗大学的Kelsey M. Smith等人,确定LGI1-抗体脑炎患者的长期发作结果,并确定与复发和发展为慢性癫痫有关的临床因素。最后,评估慢性类固醇疏通免疫疗法在长期结果中的价值。

他们在梅奥诊所的电子病历和神经免疫学实验室记录中确定了与LGI1-抗体脑炎相关的癫痫发作患者,且从发病起随访时间≥24个月。审查病历以确定临床因素、发作类型、影像学、治疗、复发的发生和结果。进行逻辑回归分析以确定慢性癫痫发展的预测因素。采用单变量Cox比例危害回归法来研究基线特征对复发风险的影响。


他们发现了49名患有LGI1-抗体脑炎和急性症状性癫痫发作的患者。几乎所有患者(n=48,98%)都接受了免疫治疗。在最后一次随访中,有8人明确,2人可能有慢性癫痫(10/49,20.4%)。

女性(P=0.048)和发病时年龄较小(P=0.02)与慢性癫痫的发展有关。

20人(40.8%)出现复发,首次复发的中位时间为7.5个月(范围3-94个月)。慢性类固醇疏通免疫疗法的初始治疗与复发风险的降低有关(危险比=0.28,95%CI 0.11-0.73,P=0.009)。

这个研究的重要意义在于发现了,尽管进行了积极的免疫治疗,20.4%的LGI1-抗体脑炎患者发生了慢性癫痫。慢性癫痫的危险因素是女性和较早发病的年龄。在长期随访的患者中,40.8%的患者发生了复发,慢性类固醇疏通免疫疗法与较低的复发率有关

原文出处
Smith KM, Dubey D, Liebo GB, Flanagan EP, Britton JW. Clinical Course and Features of Seizures Associated With LGI1-Antibody Encephalitis. Neurology. 2021 Jul 7:10.1212/WNL.0000000000012465. doi: 10.1212/WNL.0000000000012465. Epub ahead of print. PMID: 34233939.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2001411, encodeId=5e812001411f1, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sun Jan 02 23:41:51 CST 2022, time=2022-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1000988, encodeId=09d61000988ae, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210624/3da0b4e87d244fc8964a8bc9c1f7d3b8/e4798d77bda342298fe093b744b40344.jpg, createdBy=e2623291388, createdName=Avigo, createdTime=Mon Jul 19 23:44:41 CST 2021, time=2021-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343611, encodeId=217b1343611b6, content=<a href='/topic/show?id=928a849314c' target=_blank style='color:#2F92EE;'>#脑炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84931, encryptionId=928a849314c, topicName=脑炎)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Mon Jul 19 10:41:51 CST 2021, time=2021-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1000703, encodeId=58921000e03d8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210624/3da0b4e87d244fc8964a8bc9c1f7d3b8/e4798d77bda342298fe093b744b40344.jpg, createdBy=e2623291388, createdName=Avigo, createdTime=Sun Jul 18 22:35:11 CST 2021, time=2021-07-18, status=1, ipAttribution=)]
    2022-01-02 yinhl1978
  2. [GetPortalCommentsPageByObjectIdResponse(id=2001411, encodeId=5e812001411f1, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sun Jan 02 23:41:51 CST 2022, time=2022-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1000988, encodeId=09d61000988ae, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210624/3da0b4e87d244fc8964a8bc9c1f7d3b8/e4798d77bda342298fe093b744b40344.jpg, createdBy=e2623291388, createdName=Avigo, createdTime=Mon Jul 19 23:44:41 CST 2021, time=2021-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343611, encodeId=217b1343611b6, content=<a href='/topic/show?id=928a849314c' target=_blank style='color:#2F92EE;'>#脑炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84931, encryptionId=928a849314c, topicName=脑炎)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Mon Jul 19 10:41:51 CST 2021, time=2021-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1000703, encodeId=58921000e03d8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210624/3da0b4e87d244fc8964a8bc9c1f7d3b8/e4798d77bda342298fe093b744b40344.jpg, createdBy=e2623291388, createdName=Avigo, createdTime=Sun Jul 18 22:35:11 CST 2021, time=2021-07-18, status=1, ipAttribution=)]
    2021-07-19 Avigo

    学习学习

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2001411, encodeId=5e812001411f1, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sun Jan 02 23:41:51 CST 2022, time=2022-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1000988, encodeId=09d61000988ae, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210624/3da0b4e87d244fc8964a8bc9c1f7d3b8/e4798d77bda342298fe093b744b40344.jpg, createdBy=e2623291388, createdName=Avigo, createdTime=Mon Jul 19 23:44:41 CST 2021, time=2021-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343611, encodeId=217b1343611b6, content=<a href='/topic/show?id=928a849314c' target=_blank style='color:#2F92EE;'>#脑炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84931, encryptionId=928a849314c, topicName=脑炎)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Mon Jul 19 10:41:51 CST 2021, time=2021-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1000703, encodeId=58921000e03d8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210624/3da0b4e87d244fc8964a8bc9c1f7d3b8/e4798d77bda342298fe093b744b40344.jpg, createdBy=e2623291388, createdName=Avigo, createdTime=Sun Jul 18 22:35:11 CST 2021, time=2021-07-18, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=2001411, encodeId=5e812001411f1, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sun Jan 02 23:41:51 CST 2022, time=2022-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1000988, encodeId=09d61000988ae, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210624/3da0b4e87d244fc8964a8bc9c1f7d3b8/e4798d77bda342298fe093b744b40344.jpg, createdBy=e2623291388, createdName=Avigo, createdTime=Mon Jul 19 23:44:41 CST 2021, time=2021-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343611, encodeId=217b1343611b6, content=<a href='/topic/show?id=928a849314c' target=_blank style='color:#2F92EE;'>#脑炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84931, encryptionId=928a849314c, topicName=脑炎)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/22AEC2EC4805C29C6E1DEE6D888DB41C/100, createdBy=7a322500193, createdName=ms1779634646866130, createdTime=Mon Jul 19 10:41:51 CST 2021, time=2021-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1000703, encodeId=58921000e03d8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210624/3da0b4e87d244fc8964a8bc9c1f7d3b8/e4798d77bda342298fe093b744b40344.jpg, createdBy=e2623291388, createdName=Avigo, createdTime=Sun Jul 18 22:35:11 CST 2021, time=2021-07-18, status=1, ipAttribution=)]
    2021-07-18 Avigo

    学习学习

    0

相关资讯

Ann Neurol-哈佛大学新发现:人工智能,助力癫痫诊疗

哈佛大学新发现:人工智能,助力癫痫诊疗

Neurology:一线抗癫痫治疗后,行昏迷诱导治疗并不增加并发症

一线抗癫痫治疗后,行昏迷诱导治疗并不增加并发症

Epilepsia:体育训练可以改善成人癫痫患者的执行功能

癫痫是一种慢性非传染性的脑部疾病,影响着全世界所有年龄段的近5000万人。抗癫痫药物对认知功能的影响是造成癫痫患者负担的主要原因之一。近年来,有学者提出,体育锻炼可能是一种低成本非药物治疗方法,可减少

Pediatrics:新生儿癫痫,苯巴比妥治疗效果不佳,试试左乙拉西坦

目前还没有美国食品和药物管理局批准的用于治疗新生儿癫痫发作的方法。苯巴比妥和苯妥英常不能控制新生儿癫痫的发作。此外,也担忧癫痫药物对婴儿大脑发育的影响。左乙拉西坦在老年患者中已被证明具有疗效和良好的安

Epilepsia:抗癫痫药物增加重大心血管事件风险

服用抗癫痫药物的癫痫患者发生重大心血管事件的风险增加。该研究强调了心血管风险管理在癫痫患者临床护理中的重要性。

Acta Neurol Scand:拉考沙胺可有效且安全的治疗脑血管病因的癫痫患者

脑血管疾病,特别是脑卒中,是老年人新发癫痫的最常见原因之一。拉考沙胺是一种非酶诱导的抗癫痫药物,适用于4岁及以上患者局灶性癫痫的单药和辅助治疗。临床前研究表明拉考沙胺有神经保护作用。一项小规模试点研究