title: Epilepsy surgery in drug resistant temporal lobe epilepsy associated with neuronal antibodies.
abstract: We assessed the outcome of patients with drug resistant epilepsy and neuronal antibodies who underwent epilepsy surgery. Retrospective study, information collected with a questionnaire sent to epilepsy surgery centers. Thirteen patients identified, with antibodies to GAD (8), Ma2 (2), Hu (1), LGI1 (1) or CASPR2 (1). Mean age at seizure onset: 23 years. Five patients had an encephalitic phase. Three had testicular tumors and five had autoimmune diseases. All had drug resistant temporal lobe epilepsy (median: 20 seizures/month). MRI showed unilateral temporal lobe abnormalities (mainly hippocampal sclerosis) in 9 patients, bilateral abnormalities in 3, and was normal in 1. Surgical procedures included anteromesial temporal lobectomy (10 patients), selective amygdalohippocampectomy (1), temporal pole resection (1) and radiofrequency ablation of mesial structures (1). Perivascular lymphocytic infiltrates were seen in 7/12 patients. One year outcome available in all patients, at 3 years in 9. At last visit 5/13 patients (38.5%) (with Ma2, Hu, LGI1, and 2 GAD antibodies) were in Engel's classes I or II. Epilepsy surgery may be an option for patients with drug resistant seizures associated with neuronal antibodies. Outcome seems to be worse than that expected in other etiologies, even in the presence of unilateral HS. Intracranial EEG may be required in some patients.
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain. Electronic address: mcarreno@clinic.ub.es.
authors.forename: Mar
authors.initials: M
authors.lastname: Carreño
authors.affiliation: Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany. Electronic address: christian.bien@mara.de.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Bien
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: aliasadipooya@yahoo.com.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Asadi-Pooya
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: Michael.Sperling@jefferson.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Sperling
authors.affiliation: Dpt. of Neurology, Charles University in Prague, 2nd Faculty of Medicine Motol University Hospital, Prague, Czechia. Electronic address: petr.marusic@fnmotol.cz.
authors.forename: Petr
authors.initials: P
authors.lastname: Marusic
authors.affiliation: Dpt. of Neurology, Charles University in Prague, 2nd Faculty of Medicine Motol University Hospital, Prague, Czechia. Electronic address: martin.elisak@gmail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Elisak
authors.affiliation: Department of Neurology, Faculty of Medicine of the University of Lisbon- Hospital de Santa Maria, Lisbon, Portugal. Electronic address: josepimentel@medicina.ulisboa.pt.
authors.forename: Jose
authors.initials: J
authors.lastname: Pimentel
authors.affiliation: Institute of Neurology, University College London, UK. Electronic address: t.wehner@ucl.ac.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Wehner
authors.affiliation: Salford Royal NHS Foundation Trust, UK. Electronic address: Rajiv.Mohanraj@srft.nhs.uk.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Mohanraj
authors.affiliation: Department of Neurology, Clinic of Sagrado Corazón, Sevilla, Spain. Electronic address: juanuranga@telefonica.net.
authors.forename: Juan
authors.initials: J
authors.lastname: Uranga
authors.affiliation: Department of Neurology, Hospital la Fe, Valencia, Spain. Electronic address: asiergomez81@gmail.com.
authors.forename: Asier
authors.initials: A
authors.lastname: Gómez-Ibáñez
authors.affiliation: Department of Neurology, Hospital la Fe, Valencia, Spain. Electronic address: vevillanuevah@yahoo.es.
authors.forename: Vicente
authors.initials: V
authors.lastname: Villanueva
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain. Electronic address: fgil@clinic.ub.es.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gil
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain. Electronic address: jdonaire@clinic.cat.
authors.forename: Antonio
authors.initials: A
authors.lastname: Donaire
authors.affiliation: Epilepsy Unit, Department of Radiology, Hospital Clínic, Barcelona, Spain. Electronic address: bargallo@clinic.cat.
authors.forename: Nuria
authors.initials: N
authors.lastname: Bargalló
authors.affiliation: Epilepsy Unit, Department of Neurosurgery, Hospital Clínic, Barcelona, Spain. Electronic address: jrumia@clinic.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rumià
authors.affiliation: Epilepsy Unit, Department of Neurosurgery, Hospital Clínic, Barcelona, Spain. Electronic address: Peroldan@clinic.cat.
authors.forename: Pedro
authors.initials: P
authors.lastname: Roldán
authors.affiliation: Epilepsy Unit, Department of Nuclear Medicine, Hospital Clínic, Barcelona, Spain. Electronic address: setoain@clinic.ub.es.
authors.forename: Xavier
authors.initials: X
authors.lastname: Setoain
authors.affiliation: Epilepsy Unit, Department of Psychiatry, Hospital Clínic, Barcelona, Spain. Electronic address: lpintor@clinic.ub.es.
authors.forename: Luis
authors.initials: L
authors.lastname: Pintor
authors.affiliation: Epilepsy Unit, Department of Psychiatry, Hospital Clínic, Barcelona, Spain. Electronic address: tboget@clinic.cat.
authors.forename: Teresa
authors.initials: T
authors.lastname: Boget
authors.affiliation: Epilepsy Unit, Hospital Clínic, Barcelona Spain; University Pompeu-Fabra, Barcelona, Spain. Electronic address: ebailles@gmail.com.
authors.forename: Eva
authors.initials: E
authors.lastname: Bailles
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Bellvitge, Barcelona, Spain. Electronic address: mfalip@bellvitgehospital.cat.
authors.forename: Mercè
authors.initials: M
authors.lastname: Falip
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain. Electronic address: japarici@clinic.ub.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Aparicio
authors.affiliation: ICREA-IDIBAPS and Department of Neurology, Hospital Clínic, Barcelona, Spain; University of Pennsylvania, USA.
authors.forename: Josep
authors.initials: J
authors.lastname: Dalmau
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain. Electronic address: FGraus@clinic.ub.es.
authors.forename: Francesc
authors.initials: F
authors.lastname: Graus
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood* / Q000134:cerebrospinal fluid*; D015415:Biomarkers / Q000097:blood; D001921:Brain / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology / Q000601:surgery; D002648:Child; D000069279:Drug Resistant Epilepsy / Q000150:complications / Q000000981:diagnostic imaging / Q000276:immunology* / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000000981:diagnostic imaging / Q000276:immunology* / Q000601:surgery*; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D015415:Biomarkers
keywords: GAD; Hippocampal sclerosis; LGI1; Ma2; Temporal lobectomy