Testing & Treatment for

Autoimmune Seizures

Antibody Testing for Autoimmune Seizures

An autoimmune epilepsy diagnosis can be supported by the presence of neuronal antibodies in serum, which are most commonly directed against particular neuronal antigens. ¹

Research has identified a number of neural antibodies that are commonly associated with seizures of autoimmune etiology, such as LGI1 and GAD65.² However, not all autoimmune antibody targets have yet been identified.

Some individuals may have autoimmune-induced seizures “even without underlying antibody positivity, which may reflect the yet undiscovered array of neuronal antibodies that could result in autoimmune epilepsy.” ³

Testing for neural autoantibodies is an important part of the work up and diagnosis of patients with seizures of autoimmune etiology.”

The Cunningham Panel™ includes testing for several autoantibodies that may be associated with seizures including anti-dopamine D1, anti-dopamine D2, anti-lysoganglioside GM1, and anti-tubulin and autoantibodies that stimulate calcium/calmodulin-dependent protein kinase II in human brain cells.

The Panel can assist clinicians in diagnosing an underlying autoimmune etiology in patients with neurologic and/or psychiatric symptoms, including those with treatment-resistant seizures.

Several recent case studies demonstrate the clinical utility of the Cunningham Panel in identifying patients with autoimmune seizures and its impact in guiding treatment.

Treatment for Immune-mediated Seizures

Patients with autoimmune epilepsy typically do not respond to antiseizure medications alone, although some reports have found antiseizure medications with sodium channel blocking properties to have greater efficacy. ⁴

Treatment for autoimmune-triggered seizures can include steroids, immunoglobulin (IVIG) and plasmapheresis depending on the setting of treatment, the severity of seizures, and other patient characteristics. In paraneoplastic autoimmune epilepsy, it is necessary to treat the underlying tumor. ⁶

Early diagnosis of autoimmune epilepsy is critical, as proper treatment often leads to a complete resolution of seizures. In fact, one study reports, after immunotherapy 81% of patients had “significant improvement in seizure status and 67% achieved seizure freedom, a majority of whom were antiepileptic drug [AED] resistant.” ⁵

REFERENCES

Zelano J, Axelsson M, Constantinescu R, Malmeström C, Kumlien E. Neuronal antibodies in adult patients with new-onset seizures: A prospective study. Brain Behav. 2019 Nov;9(11):e01442. doi: 10.1002/brb3.1442. Epub 2019 Oct 6. PMID: 31588654; PMCID: PMC6851805.
Quek, A. M. L., Britton, J. W., McKeon, A., So, E., Lennon, V. A., Shin, C., Klein, C. J., Watson, R. E., Kotsenas, A. L., Lagerlund, T. D., Cascino, G. D., Worrell, G. A., Wirrell, E. C., Nickels, K. C., Aksamit, A. J., Noe, K. H., & Pittock, S. J. (2012). Autoimmune epilepsy: Clinical characteristics and response to immunotherapy. Archives of neurology, 69(5), 582-593.
Dubey D, Samudra N, Gupta P, Agostini M, Ding K, Van Ness PC, Vernino S, Hays R. Retrospective case series of the clinical features, management and outcomes of patients with autoimmune epilepsy. Seizure. 2015 Jul;29:143-7. doi: 10.1016/j.seizure.2015.04.007. Epub 2015 Apr 30. PMID: 26076858.
Eyissa AM, López Chiriboga AS, Britton JW. Antiepileptic drug therapy in patients with autoimmune epilepsy. Neurol Neuroimmunol Neuroinflamm. 2017 May 10;4(4):e353.
Fang Z, Yang Y, Chen X, Zhang W, Xie Y, Chen Y, Liu Z, Yuan W. Advances in Autoimmune Epilepsy Associated with Antibodies, Their Potential Pathogenic Molecular Mechanisms, and Current Recommended Immunotherapies. Front Immunol. 2017 Apr 25;8:395. doi: 10.3389/fimmu.2017.00395. PMID: 28487693; PMCID: PMC5403900.
Britton, J.W., Flanagan, E.P., McKeon, A. and Pittock, S.J. (2021). Autoimmune Epilepsy Disorders. In Epilepsy (eds G. D Cascino, J. I Sirven and W. O Tatum).