Autoimmune Epilepsy Disorders

This chapter reviews the clinical features, electroencephalogram (EEG) and magnetic resonance imaging (MRI) findings, serologic testing, clinical scoring scales, and treatment of autoimmune epilepsy syndromes. It focuses on the autoimmune epilepsies associated with neural IgG autoantibodies. The majority of patients with seizures of autoimmune etiology present with focal seizures, either with or without impaired awareness. Bilateral tonic–clonic seizures secondary to propagation from focal seizures are common as well. Other patients may present in status epilepticus. A number of clinical seizure characteristics should raise suspicion of an autoimmune cause. EEG can be helpful in the evaluation of patients with autoimmune epilepsy, but the findings are often nonspecific. Recognition of the clinical, EEG and MRI features, and familiarity with diagnostic criteria and clinical scoring systems, facilitates early recognition and diagnosis. The chapter also presents a general approach to treatment, followed by discussion regarding treatment of specific antibody-associated encephalitides.