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Neuronal autoantibodies in epilepsy patients with peri-ictal autonomic findings

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Abstract

Autonomic dysfunction has frequently been reported in autoimmune encephalitis associated with seizures and there is growing evidence that epilepsy patients may display neuronal autoantibodies (NAAb). The aim of this study was to investigate the frequency of NAAb in epilepsy patients with peri-ictal autonomic findings. Fifty-eight patients (37 women/21 men; average age of 34.2 ± 9.9 years and epilepsy duration of 19.1 ± 9.6 years) who had at least one video-EEG recorded focal or secondary generalized seizure with clear-cut documented peri-ictal autonomic findings, or consistently reported seizures with autonomic semiology, were included. NAAb were tested by RIA or cell based assays. NAAb were present in 17 of 58 (29.3 %) patients. Among seropositive patients, antibodies were directed against N-methyl-d-aspartate receptor (NMDAR) in 5 (29 %), contactin-associated protein-like 2 (CASPR2) in 5 (29 %), uncharacterized voltage gated potassium channel (VGKC)-complex antigens in 3 (18 %), glutamic acid decarboxylase (GAD) in 2 (12 %), glycine receptor (GLYR) in one (6 %) and type A gamma aminobutyric acid receptor (GABAAR) in one patient (6 %). Peri-ictal gastrointestinal manifestations, piloerection, ictal fever, urinary urge, and cough occurred more commonly in the seropositive group. The prevalences of psychotic attacks and status epilepticus were significantly increased in the seropositive group. Seropositivity prevalence in our patient group with peri-ictal autonomic findings is higher than other previously reported epilepsy cohorts. In our study, ictal fever-VGKC-complex antibody and pilomotor seizure-GABAAR antibody associations were documented for the first time. Chronic epilepsy patients with peri-ictal autonomic semiology, history of status epilepticus and psychotic disorder may benefit from autoantibody screening.

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Acknowledgments

Our study was supported by the Turkish Scientific and Technical Research Council with a number of 214S170 and Istanbul University Research Fund with a number BAP-39616.

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Authors and Affiliations

  1. Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Capa, Fatih, Istanbul, Turkey

    Leyla Baysal-Kirac, Ebru Nur Vanli-Yavuz, Esme Ekizoglu, Mine Sezgin, Nerses Bebek, Candan Gurses, Aysen Gokyigit & Betul Baykan

  2. Department of Neuroscience, Institute of Experimental Medical Research, Istanbul University, Istanbul, Turkey

    Erdem Tuzun, Ece Erdag & Canan Ulusoy

  3. Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK

    Sian Peach & Angela Vincent

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  1. Leyla Baysal-Kirac
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Correspondence to Leyla Baysal-Kirac.

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Baysal-Kirac, L., Tuzun, E., Erdag, E. et al. Neuronal autoantibodies in epilepsy patients with peri-ictal autonomic findings. J Neurol 263, 455–466 (2016). https://doi.org/10.1007/s00415-015-8002-2

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  • DOI: https://doi.org/10.1007/s00415-015-8002-2

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