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Advances in Steroid-Responsive Encephalopathy

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Front. Neurol. | doi: 10.3389/fneur.2019.00025

The Different Clinical Features between Autoimmune and Infectious Status Epilepticus

 Chih-Hsiang Lin1, Yan-Ting Lu1,  Chen-Jui Ho1, Fu-Yuan Shih1 and  Meng-Han Tsai1*
  • 1Kaohsiung Chang Gung Memorial Hospital, Taiwan

Objective: The prognosis of status epilepticus (SE) is highly related to the underlying etiology. Inflammation of the central nervous system (CNS), including infection and autoimmune encephalitis, is one of the treatable conditions causing SE. The initial presentation of infectious and autoimmune CNS disorders can be quite similar, which may be difficult to differentiate at the beginning. However, treatment for these entities can be quite different. In this study, we aim to identify the differences in clinical features among patients with infectious and autoimmune SE, which could help the clinicians to select initial investigation and ensuing therapies that may improve overall outcomes.
Methods: This was a retrospective study that included 501 patients with SE within a period of 10.5 years. Patients with inflammatory etiology were collected and separated into infectious and autoimmune SE. The symptoms at onset, SE semiology, status epilepticus severity score and END-IT score at admission, treatment for SE, and outcome (modified Rankin Scale) on discharge and last follow-up were recorded. Data on the first cerebrospinal fluid, electroencephalography, and magnetic resonance imaging were also collected.
Results: Forty-six (9.2%) of the 501 patients had SE with inflammatory etiology. Twenty-five (5%) patients were autoimmune SE and 21 (4.2%) were infectious SE. Patients with autoimmune SE have younger age and female predominance. As for clinical presentations, psychosis, non-convulsive SE, and super refractory SE were more common in patients with autoimmune SE. Nevertheless, the prognosis showed no difference between the two groups.
Conclusion: The different initial clinical presentations and patient characteristics may provide some clues about the underlying etiology of SE. When inflammatory etiology is suspected in patients with SE, younger age, female sex, psychosis, non-convulsive SE and super refractory SE are clinical features that suggest an autoimmune etiology.

Keywords: Status Epilepticus, Inflammatory, Autoimmune, Infection, Autoantibody

Received: 11 Jul 2018; Accepted: 09 Jan 2019.

Edited by:

Patrick Kwan, Van Cleef Roet Centre for Nervous Diseases, Monash University, Australia

Reviewed by:

Sonja Hochmeister, Medical University of Graz, Austria
Adam Strzelczyk, Universitätsklinikum Frankfurt, Germany  

Copyright: © 2019 Lin, Lu, Ho, Shih and Tsai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Meng-Han Tsai, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, menghan@cgmh.org.tw