Abstract Details

Title Autoimmune epilepsy, a rare diagnosis, or an underdiagnosed condition?

Topic Autoimmune Neurology

Presentation(s) Autoimmune Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 079

Objective NA

Background Autoimmune epilepsy is a rare condition that has recently gained recognition as it is treatable. Multiple autoimmune targets have been identified as a potential cause for resistant epilepsy, however, it remains under-recognized with a current prevalence of 14/100,000. It takes a high degree of suspicion to consider autoimmune epilepsy in the differential diagnosis. Currently, with easily available rapid antibody testing, especially in patients with new onset refractory epilepsy – the diagnosis of autoimmune epilepsy must not be missed.

Design/Methods We present two cases of non-infectious autoimmune Epilepsy that presented to a community hospital.
A 24-year-old male with diabetes presented with left temporal headache, cognitive impairment and intermittent aphasia for three weeks. He was initially diagnosed to have a psychiatric vs functional neurological disorder. After a detailed history, an EEG obtained showed multiple left temporal seizures. MRI brain showed no structural lesions. Despite initiating multiple AEDs, no response was noted. An LP was performed, GAD-65 was positive in the CSF.
Our second case is a 36-year-old female with a history of seizures in childhood presented with a breakthrough seizure and a recent admission to a psychiatric facility. An MRI showed left temporal and insular T2 hyperintensity, correlating with an EEG finding of left temporal seizures refractory to multiple AEDs. LP revealed GABA-B Ab in CSF. A CT-abdomen-pelvis did not reveal an underlying malignancy.

Results Despite AEDs, no response was noted in either case. After the administration of steroids, seizure control was achieved in the male patient with GAD-65 antibody. A similar response was achieved in the second case, after she was started on steroids and Rituximab delineating a response to an underlying autoimmune pathology.

Conclusions

Multiple cases present with seizures; however, a high index of suspicion should be maintained for an autoimmune condition, especially when a patient has new-onset refractory seizures.

Authors/Disclosures
Khaled Abdalla, MD (Winchester neurological consultants) PRESENTER	Dr. Abdalla has nothing to disclose.
Aparna M. Prabhu, MD	Dr. Prabhu has nothing to disclose.

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