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Editorial
April 12, 2019

Recognizing autoimmune encephalitis as a cause of seizures
Treating cause and not effect

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Jeffrey W. Britton, MD, and Josep Dalmau, MDAuthors Info & Affiliations
May 7, 2019 issue
92 (19) 877-878
https://doi.org/10.1212/WNL.0000000000007444
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Abstract

In this issue of Neurology®, de Bruijn et al.1 report the difference in efficacy between immunotherapy and antiseizure medications (ASMs) in the treatment of seizures secondary to autoimmune encephalitis. Immunotherapy efficacy clearly exceeded that of ASMs in this cohort with anti–leucine-rich glioma-inactivated 1 (LGI1), anti-NMDA receptor (NMDAR), and anti–gamma-aminobutyric acid B receptor (GABABR) encephalitis on a number of fronts: 53% became seizure-free shortly after initiation of immunotherapy compared to 14% with ASMs and time to seizure freedom with immunotherapy was 28 days vs 59 days in those few who became seizure-free with ASMs. Eventually, 89% became seizure-free following immunotherapy, and ASM therapy could eventually be discontinued in nearly all patients.

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References

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Information & Authors

Information

Published In

Neurology®
Volume 92 • Number 19 • May 7, 2019
Pages: 877-878
PubMed: 30979858

Copyright

© 2019 American Academy of Neurology.

Publication History

Published online: April 12, 2019
Published in print: May 7, 2019

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Disclosure

Dr. Britton was an unpaid coinvestigator for the following: IVIg in VGKC encephalitis, a randomized controlled trial (Grifols Pharmaceuticals); Cannabidiol in refractory epilepsy secondary to tuberous sclerosis (Greenwich Pharmaceuticals); and An open label extension study to investigate the safety of cannabidiol (GWP42003-P; CBD) in children and adults with inadequately controlled Dravet or Lennox-Gastaut syndromes (Greenwich Pharmaceuticals). Dr. Dalmau receives royalties from Athena Diagnostics for the use of Ma2 as an autoantibody test and Euroimmun AG for the use of NMDA receptor, GABAB receptor, GABAA receptor, DPPX, and IgLON5 as autoantibody tests. Go to Neurology.org/N for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Jeffrey W. Britton, MD
From the Division of Epilepsy (J.W.B.) and ICREA and Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic (J.D.), Universitat de Barcelona, Spain; and Department of Neurology(J.D.), University of Pennsylvania, Philadelphia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
Unpaid co-investigator clinical trials: -A Randomized Double Blind Placebo Controlled Study of IVIG in Patients with Voltage Gated Potassium Channel Complex Antibody Associated Autoimmune Epilepsy - Grifols Pharmaceuticals -A double-blind, randomized, placebo-controlled study to investigate the efficacy and safety of cannabidiol (GWP42003-P, CBD) as add-on therapy in patients with tuberous sclerosis complex who experience inadequately- controlled seizures- Greenwich Pharmaceuticals - An open label extension study to investigate the safety of cannabidiol (GWP42003-P; CBD) in children and adults with inadequately controlled Dravet or Lennox-Gastaut Syndromes - Greenwich Pharmaceuticals
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Mr. and Mrs. David Hawk charitable gift for epilepsy research
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Josep Dalmau, MD
From the Division of Epilepsy (J.W.B.) and ICREA and Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic (J.D.), Universitat de Barcelona, Spain; and Department of Neurology(J.D.), University of Pennsylvania, Philadelphia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Neurology, Neuroimmunology and Neuroinflammation Neurology UpToDate
Patents:
1.
Patent for Ma2 autoantibody test: US 6,387,639; Issued May 14th, 2002. Patent for NMDA receptor autoantibody test: US 7,972,796 B2 July 5, 2011; European 2057466. Patent for GABAb receptor autoantibody test: US 8,685,656; European 2483417; Patents filed for GABA(A) receptor autoantibody test, DPPX autoantibody test, and IgLON5 autoantibody test.
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Advance Medical
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
-NIH, RO1NS077851, PI, 2011-2018 -Instituto Carlos III/FEDER (FIS, 14/00203 and CIBERER CB15/00010, and Proyectos Integrados de Excelencia, PIE 16/00014). -Agencia de Gestio d'Ajuts Universitaris i de Recerca (AGAUR), and CERCA Programme Generalitat de Catalunya -Fundacio CELLEX
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NMDA receptor autoantibody test/Euroimmun GABA(B)R autoantibody test/Euroimmun GABA(A)R autoantibody test/Euroimmun DPPX autoantibody test/Euroimmun Iglon5 autoantibody test/Euroimmun
Royalty Payments, Technology or Inventions:
1.
Patent Ma2 autoantibody test Patent NMDAR autoantibody test Patent GABA(B) receptor autoantibody test Patent application for the use of GABA(A) receptor, DPPX and IgLON5 autoantiboddy tests
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author

Notes

Correspondence Dr. Britton [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.

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