Paraneoplastic epilepsy.
Epilepsy can be a manifestation of paraneoplastic syndromes which are the consequence of an immune reaction to neuronal elements driven by an underlying malignancy affecting other organs and tissues. The antibodies commonly found in paraneoplastic encephalitis can be divided into two main groups depending on the target antigen: 1) antibodies against neuronal cell surface antigens, such as against neurotransmitter (N-methyl-d-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), gamma-aminobutyric acid (GABA)) receptors, ion channels (voltage-gated potassium channel (VGKC)), and channel-complex proteins (leucine rich, glioma inactivated-1 glycoprotein (LGI1) and contactin-associated protein-2 (CASPR2)) and 2) antibodies against intracellular neuronal antigens (Hu/antineuronal nuclear antibody-1 (ANNA-1), Ma2/Ta, glutamate decarboxylase 65 (GAD65), less frequently to CV2/collapsin response mediator protein 5 (CRMP5)). In this review, we provide a comprehensive survey of the current literature on paraneoplastic epilepsy indexed by the associated onconeuronal antibodies. While a range of seizure types can be seen with paraneoplastic syndromes, temporal lobe epilepsy is the most common because of the association with limbic encephalitis. Early treatment of the paraneoplastic syndrome with immune modulation/suppression may prevent the more serious potential consequences of paraneoplastic epilepsy.
Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Anna
A
Serafini
Department of Neurology, University of Chicago, Chicago, IL 60637, USA.
Rimas V
RV
Lukas
Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Stephen
S
VanHaerents
Section of Neurosurgery, University of Chicago, Chicago, IL 60637, USA.
Peter
P
Warnke
Department of Neurology, University of Chicago, Chicago, IL 60637, USA.
James X
JX
Tao
Department of Neurology, University of Chicago, Chicago, IL 60637, USA.
Sandra
S
Rose
Department of Neurology, University of Chicago, Chicago, IL 60637, USA. Electronic address: swu4@neurology.bsd.uchicago.edu.
Shasha
S
Wu
D001327:Autoimmune Diseases; D004660:Encephalitis / Q000150:complications; D004827:Epilepsy / Q000209:etiology* / Q000276:immunology / Q000628:therapy*; D006801:Humans; D020361:Paraneoplastic Syndromes, Nervous System / Q000150:complications* / Q000276:immunology / Q000628:therapy*; D024642:Potassium Channels, Voltage-Gated; D011379:Prognosis
D024642:Potassium Channels, Voltage-Gated
Autoimmune epilepsy; Medically intractable epilepsy; Onconeuronal antibody; Paraneoplastic encephalitis; Paraneoplastic neurological syndrome