Autoimmune Epilepsy

Diagnosis

Autoimmune epilepsy is a type of epilepsy caused by the immune system attacking brain cells. Diagnosis begins with a physical exam and a detailed review of symptoms.

• Lab tests: Detect antibodies in the blood or cerebrospinal fluid (CSF). CSF is collected via a lumbar puncture, where a needle removes fluid from the lower back for testing. Some people with autoimmune epilepsy may not have detectable antibodies.

• Brain imaging:

  • MRI identifies signs of autoimmune epilepsy and rules out other causes of seizures.

  • FDG-PET scan evaluates brain metabolism to help detect types of autoimmune encephalitis that can cause seizures.

• Electroencephalogram (EEG): Measures electrical activity in the brain. Video EEG may be used to record seizure events and confirm diagnosis.

Treatment

Autoimmune epilepsy treatment differs from standard epilepsy therapy. It primarily focuses on immunotherapy to reduce immune system attacks on brain cells.

Immunotherapy

• High-dose corticosteroids:

  • Methylprednisolone (Solu-Medrol) IV for up to 5 days, followed by tapered doses.

  • Prednisone oral therapy may also be used, starting with high doses and gradually tapering.

• Immunoglobulin (IVIg): Administered via IV for several days, followed by lower maintenance doses.

• Other long-acting immunotherapy medicines: May include rituximab, cyclophosphamide, mycophenolate, azathioprine, or tocilizumab, depending on response.

Plasma Exchange

• Removes antibodies causing brain inflammation.

• The liquid part of the blood is separated, and blood cells are returned to the body. New plasma is naturally produced.

Antiseizure Medicines

• Standard antiseizure medicines may have limited effectiveness in autoimmune epilepsy.

• If immunotherapy successfully controls seizures, doctors may gradually taper antiseizure medicines.

• People with certain antibodies, such as GAD65, may have lower chances of becoming seizure-free.

Rehabilitation

• If autoimmune epilepsy affects memory, speech, or other functions, occupational and speech therapy can support recovery.

Surgeries

• Rasmussen syndrome, primarily affecting children, usually does not respond to medication.

• Brain surgery may be required to control seizures in this form of autoimmune epilepsy.