Full-Length Original Research
Prevalence of neurologic autoantibodies in cohorts of patients with new and established epilepsy
Article first published online: 6 MAR 2013
Wiley Periodicals, Inc. © 2013 International League Against Epilepsy
Volume 54, Issue 6, pages 1028–1035, June 2013
How to Cite
Brenner, T., Sills, G. J., Hart, Y., Howell, S., Waters, P., Brodie, M. J., Vincent, A. and Lang, B. (2013), Prevalence of neurologic autoantibodies in cohorts of patients with new and established epilepsy. Epilepsia, 54: 1028–1035. doi: 10.1111/epi.12127
- Issue published online: 4 JUN 2013
- Article first published online: 6 MAR 2013
- Manuscript Accepted: 17 JAN 2013
- Epilepsy Research UK
- NHS Greater Glasgow (West Research Endowment Funds)
- NIHR Oxford Biomedical Research Centre
- Established epilepsy;
- Newly diagnosed epilepsy;
- Voltage-gated potassium channel complex;
- Glutamic acid decarboxylase;
- NMDA receptor;
- Glycine receptor
Autoantibodies to specific neurologic proteins are associated with subacute onset encephalopathies, which often present with seizures that are poorly controlled by conventional antiepileptic drugs (AEDs). Previous cross-sectional studies have found specific neurologic antibodies in a small proportion of people with established epilepsy, but these investigations have seldom included patients with recent diagnosis.
We screened two large epilepsy cohorts to investigate the prevalence of multiple autoantibodies in adult patients with either established or newly diagnosed, untreated epilepsy.
Eleven percent of patients had antibodies to one or more antigen: voltage-gated potassium channel (VGKC) complex proteins (5%), glycine receptors (3%), and glutamic acid decarboxylase (GAD) and N-methyl-d-aspartate (NMDA) receptors (1.7% each). There was no difference in the prevalence of antibodies, individually or collectively, between patients with established and newly diagnosed epilepsy or with generalized or focal epilepsy. There was, however, a significantly higher prevalence of positive antibody titers in patients with focal epilepsy of unknown cause than in those with structural/metabolic focal epilepsy (14.8% vs. 6.3%; p < 0.02). Newly diagnosed antibody-positive patients were less likely to achieve adequate seizure control with initial treatment than antibody-negative patients, but this difference failed to reach statistical significance.
The presence of autoantibodies is equally common in newly diagnosed and established epilepsy, it is therefore unlikely to be an epiphenomenon of long-standing refractory seizures.