title: Neuronal autoantibodies in epilepsy patients with peri-ictal autonomic findings.
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.
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Capa, Fatih, Istanbul, Turkey. baysalleyla@gmail.com.
authors.forename: Leyla
authors.initials: L
authors.lastname: Baysal-Kirac
authors.affiliation: Department of Neuroscience, Institute of Experimental Medical Research, Istanbul University, Istanbul, Turkey.
authors.forename: Erdem
authors.initials: E
authors.lastname: Tuzun
authors.affiliation: Department of Neuroscience, Institute of Experimental Medical Research, Istanbul University, Istanbul, Turkey.
authors.forename: Ece
authors.initials: E
authors.lastname: Erdag
authors.affiliation: Department of Neuroscience, Institute of Experimental Medical Research, Istanbul University, Istanbul, Turkey.
authors.forename: Canan
authors.initials: C
authors.lastname: Ulusoy
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Capa, Fatih, Istanbul, Turkey.
authors.forename: Ebru Nur
authors.initials: EN
authors.lastname: Vanli-Yavuz
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Capa, Fatih, Istanbul, Turkey.
authors.forename: Esme
authors.initials: E
authors.lastname: Ekizoglu
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Sian
authors.initials: S
authors.lastname: Peach
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Capa, Fatih, Istanbul, Turkey.
authors.forename: Mine
authors.initials: M
authors.lastname: Sezgin
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Capa, Fatih, Istanbul, Turkey.
authors.forename: Nerses
authors.initials: N
authors.lastname: Bebek
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Capa, Fatih, Istanbul, Turkey.
authors.forename: Candan
authors.initials: C
authors.lastname: Gurses
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Capa, Fatih, Istanbul, Turkey.
authors.forename: Aysen
authors.initials: A
authors.lastname: Gokyigit
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Vincent
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Capa, Fatih, Istanbul, Turkey.
authors.forename: Betul
authors.initials: B
authors.lastname: Baykan
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D004569:Electroencephalography; D004827:Epilepsy / Q000097:blood* / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D005968:Glutamate Decarboxylase / Q000276:immunology; D006801:Humans; D008297:Male; D008565:Membrane Proteins / Q000276:immunology*; D008875:Middle Aged; D009419:Nerve Tissue Proteins / Q000276:immunology*; D024642:Potassium Channels, Voltage-Gated / Q000276:immunology; D018009:Receptors, Glycine / Q000276:immunology; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; C403049:CNTNAP2 protein, human; D008565:Membrane Proteins; D009419:Nerve Tissue Proteins; D024642:Potassium Channels, Voltage-Gated; D018009:Receptors, Glycine; D016194:Receptors, N-Methyl-D-Aspartate; D005968:Glutamate Decarboxylase
keywords: Autoimmune epilepsy; Autonomic seizure semiology; Limbic encephalitis; NMDAR; VGKC Ab