Abstract Details

Title Predictors of Remission for Refractory Paraneoplastic Epilepsy

Topic Autoimmune Neurology

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 1-003

Objective Characterize seizure burden and treatment among patients with Paraneoplastic Epilepsy. Quantify the number of patients with refractory seizures and evaluate candidacy for surgical resection.

Background Seizures are a common feature of Paraneoplastic Syndrome. Existing literature suggests that some patients with Paraneoplastic Epilepsy have poor clinical outcomes even after treatment. These patients might meet criteria for drug-resistant epilepsy and surgical resection.

Design/Methods Retrospective chart review of 45 (M=16, F=29) convenience-sampled patients diagnosed with Paraneoplastic Syndrome (PNS) between January 1, 2003 and October 31, 2023. Patients with seizures (n=26; M=12, F=14) were included in the analysis. Patients were divided into two groups based on PNS diagnosis: Anti-NMDA Receptor Encephalitis (n=10) and Other (Limbic Encephalitis (n=11), Autoimmune Encephalitis (n=3), Stiff Person Syndrome (n=2)). A two-tailed Mann-Whitney U test was utilized for statistical analysis (p<0.05).

Results Significantly fewer ambulatory anti-epileptic drugs (AEDs) were trialed in the Anti-NMDAR group (median = 2.5) compared to the Other group (median = 4.0), U=10, Z=-3.68, p<0.01, effect size r=0.72. 77% of all patients with seizures were trialed on >2 AEDs. 70% of patients in the Anti-NMDAR group achieved seizure remission by one year after initial presentation, compared to 19% of the Other group. Median seizure duration was 3.0 months (IQR 2.0-5.0 months) in the Anti-NMDAR group and 33.0 months (IQR 8.8-47.3 months) in the Other group. 100% of patients in the Anti-NMDAR group and 50% of patients in the Other group achieved seizure remission by longitudinal follow-up (75.7 ± 50.9 months post initial presentation). Of patients with seizures at longitudinal follow-up (n=8), 88% had trialed >2 AEDs, 75% had evidence of localized seizures on EEG, and 75% had an abnormal MRI at presentation.

Conclusions Mainstay treatments for Paraneoplastic Epilepsy are insufficient for an important subset of patients. Preliminary results provide justification for exploration of other epilepsy treatment options, to include resection.

Authors/Disclosures
Jerome J. Graber, MD, MPH, FAAN (University of Washington) PRESENTER	Dr. Graber has received personal compensation for serving as an employee of Binaytara Foundation. Dr. Graber has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ��ɫ��. Dr. Graber has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Dickie McCamey Attorneys at Law. Dr. Graber has a non-compensated relationship as a Editorial Board member with Neuro-Oncology: Practice, published by Oxford that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Journal of Pain and Symptom Management that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Board of Directors with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Board of Directors and Certification Exam Committee Member with United Council of Neurological Subspecialties that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Question of the Day 'app' committee and NeuroSAE and Continuum with ��ɫ�� that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Practical Neurology (BMC) that is relevant to AAN interests or activities.
Hope Willis	The institution of Miss Willis has received research support from U.S. National Institutes of Health (NIH). The institution of Miss Willis has received research support from AADI Bioscience. The institution of Miss Willis has received research support from Allen Institute.
Alaina Prince	Ms. Prince has nothing to disclose.

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