Evaluation of seizure treatment in AE

In this nationwide cohort study, by De Bruijn and colleagues, the authors evaluated the seizure responses to immunotherapy and anti-epileptic drugs (AED’s) in patients with NMDAR, LGI1, and GABAbR encephalitis.

The study included 153 patients with AE (53 LGI1, 75 NMDAR, 25 GABABR). Of those, 110 patients had epileptic seizures and were included in the study and 89% of them reached seizure freedom. At least 53% achieved seizure freedom shortly after immunotherapy, and 14% achieved seizure freedom while using only AED’s. This effect was seen in all three types of AE.  The median time to reach seizure freedom from the start of AED’s was 59 days vs. 28 days from the start of immunotherapy.

In this study, having epilepsy after treated AE was rare and seizure freedom was achieved faster and more frequently with immunotherapy than with AED’s. Patients treated earlier in the course of disease seemed to reach seizure freedom faster. This effect was most remarkable in patients with LGI1 encephalitis wherein almost half of the patients became seizure-free within a week after immunotherapy, while they had been refractory to AEDs for longer periods.

The authors concluded that immunotherapy is most important in the treatment of epileptic seizures in patients with LGI1, NMDAR, and GABABR encephalitis. The overall effect of AEDs in the symptomatic treatment of epilepsy in these patients is limited and antibody-dependent. Specific AEDs should be considered to use as add-on therapy to control seizures, but not as a primary and long-term treatment.

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