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Clinical Approach to Autoimmune Epilepsy

Journal of Clinical Neurology 2020년 16권 4호 p.519 ~ 529
Jang Yoon-Hyuk, 김동욱, 양광익, 변정익, 서종근, 노영주, 강경욱, 김대영, 김근태, 조용원, 이순태,
소속 상세정보
 ( Jang Yoon-Hyuk ) - Seoul National University Hospital Department of Neurology
김동욱 ( Kim Dong-Wook ) - Konkuk University School of Medicine Department of Neurology
양광익 ( Yang Kwang-Ik ) - Soonchunhyang University College of Medicine Cheonan Hospital Department of Neurology
변정익 ( Byun Jung-Ick ) - Kyung Hee University Hospital at Gangdong Department of Neurology
서종근 ( Seo Jong-Geun ) - Kyungpook National University School of Medicine Department of Neurology
노영주 ( No Young-Joo ) - Samsung Noble County Department of Neurology
강경욱 ( Kang Kyung-Wook ) - Chonnam National University School of Medicine Chonnam National University Hospital Department of Neurology
김대영 ( Kim Dae-Young ) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Neurology
김근태 ( Kim Keun-Tae ) - Keimyung University Dongsan Medical Center Department of Neurology
조용원 ( Cho Yong-Won ) - Keimyung University Dongsan Medical Center Department of Neurology
이순태 ( Lee Soon-Tae ) - Seoul National University Hospital Department of Neurology

Abstract


Autoimmune epilepsy is a newly emerging area of epilepsy. The concept of “autoimmune” as an etiology has recently been revisited thanks to advances in autoimmune encephalitis and precision medicine with immunotherapies. Autoimmune epilepsy presents with specific clinical manifestations, and various diagnostic approaches including cerebrospinal fluid analysis, neuroimaging, and autoantibody tests are essential for its differential diagnosis. The diagnosis is often indeterminate despite performing a thorough evaluation, and therefore empirical immunotherapy may be applied according to the judgment of the clinician. Autoimmune epilepsy often manifests as new-onset refractory status epilepticus (NORSE). A patient classified as NORSE should receive empirical immunotherapy as soon as possible. On the other hand, a morecautious, stepwise approach is recommended for autoimmune epilepsy that presents with episodic events. The type of autoimmune epilepsy is also an important factor to consider when choosing from among various immunotherapy options. Clinicians should additionally take the characteristics of antiepileptic drugs into account when using them as an adjuvant therapy. This expert opinion discusses the diagnostic and treatment approaches for autoimmune epilepsy from a practical point of view.

키워드

autoimmune epilepsy; autoimmune encephalitis; NORSE; autoimmune epilepsy treatment; autoimmune epilepsy immunotherapy; refractory status epilepticus

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