Late-onset seizures and epilepsy: Electroclinical features suggestive of autoimmune etiology.

Autor:	Morano A; Department of Human Neurosciences, Epilepsy Centre, 'Sapienza' University of Rome, Rome, Italy., Cerulli Irelli E; Department of Human Neurosciences, Epilepsy Centre, 'Sapienza' University of Rome, Rome, Italy., Salamone EM; Department of Human Neurosciences, Epilepsy Centre, 'Sapienza' University of Rome, Rome, Italy., Orlando B; Department of Human Neurosciences, Epilepsy Centre, 'Sapienza' University of Rome, Rome, Italy., Fanella M; Neurology Unit, Ospedale 'Fabrizio Spaziani', Frosinone, Italy., Tinelli E; Unit of Neuroradiology, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy., Ruffolo G; Department of Physiology and Pharmacology, Istituto Pasteur-Fondazione Cenci Bolognetti, 'Sapienza' University of Rome, Rome, Italy.; Istituto di ricerca e cura a carattere scientifico (IRCCS) San Raffaele Roma, Rome, Italy., Zuliani L; Neurology Unit, AULSS8 Berica, Vicenza, Italy., Fattouch J; Department of Human Neurosciences, Epilepsy Centre, 'Sapienza' University of Rome, Rome, Italy., Manfredi M; Department of Human Neurosciences, Epilepsy Centre, 'Sapienza' University of Rome, Rome, Italy., Giallonardo AT; Department of Human Neurosciences, Epilepsy Centre, 'Sapienza' University of Rome, Rome, Italy., Di Bonaventura C; Department of Human Neurosciences, Epilepsy Centre, 'Sapienza' University of Rome, Rome, Italy.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2022 Aug 12; Vol. 13, pp. 924859. Date of Electronic Publication: 2022 Aug 12 (Print Publication: 2022).
DOI:	10.3389/fneur.2022.924859
Abstrakt:	Introduction: Late-onset epilepsy (LOE) has recently become a topic of intense research. Besides stroke, tumors, and dementia, autoimmune encephalitis (AE) has emerged as another possible cause of recurrent seizures in the elderly, and may account for a proportion of cases of LOE of unknown origin (LOEUO). This 24-h ambulatory electroencephalography (AEEG)-based study compared patients with LOEUO and AE to identify features suggestive of immune-mediated seizures in the elderly. Materials and Methods: We retrospectively reviewed 232 AEEG examinations performed in patients over 55 years with ≥6-month follow-up, and selected 21 subjects with AE and 25 subjects with LOEUO. Clinical charts and AEEG recordings were carefully analyzed. Results: Twenty-five patients with LOEUO (12 women, mean age at onset 67.9 years) and 21 AE subjects (8 women, mean age at onset 65.7 years) were enrolled. High-frequency seizures were reported in 20/21 AE and 7/25 LOEUO cases ( p < 0.00001). Focal aware seizures were more common in AE (14/21 vs. 6/25, p = 0.00058), whereas "isolated" focal-to-bilateral tonic-clonic seizures occurred in 5/25 patients with LOEUO only ( p = 0.053). AE subjects reported ictal autonomic manifestations more frequently ( p = 0.0033). Three-hundred-seventy and 24 seizures were recorded in 13/21 patients with AE and 3/25 patients with LOEUO, respectively ( p = 0.0006). Interictal epileptiform discharges were observed in 70% of both groups, but their sleep activation was more common in AE ( p = 0.06). Conclusion: Our study shows that high-frequency focal seizures with autonomic manifestations should raise the suspicion of AE in the elderly with new-onset seizures. It also highlights the relevant contribution of AEEG, which might reduce the diagnostic delay and provide useful clues to recognize AE. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Morano, Cerulli Irelli, Salamone, Orlando, Fanella, Tinelli, Ruffolo, Zuliani, Fattouch, Manfredi, Giallonardo and Di Bonaventura.)
Databáze:	MEDLINE
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