Autoimmune epilepsy: Findings on MRi and FDG-Pet

Julie Guerin, Robert E. Watson, Carrie Carr, Greta B. Liebo, Amy L. Kotsenas

Research output: Contribution to journalReview article

Abstract

Autoimmune epilepsy (AE) is becoming increasingly recognized as a potentially reversible cause of frequent or medically intractable seizures and cognitive deterioration. We describe various presentations of autoimmune encephalopathy which have specifically presented with seizure and describe reported imaging findings. This is organized as a review of the more common autoantibodies which can specifically precipitate seizure according to the intracellular or extracellular location of the targeted antigen. For each antibody, we illustrate their pathophysiology, characteristic clinical presentations with typical effective treatments and prognoses and imaging findings on MRI and PET/CT exams. Parenchymal involvement is variable with the limbic structures typically affected; however, non-limbic cortex, cerebellum, brainstem and basal ganglia can also be involved. In the acute setting, affected regions typically demonstrate T2 hyperintensity with mild mass effect from edema and increased 18F-fludeoxyglucose uptake. Chronically involved parenchyma will often undergo atrophy and demonstrate decreased metabolism; mesial temporal sclerosis is often the end result when the limbic system is involved. Without treatment, long-term effects from AE range from ongoing cognitive dysfunction and refractory seizures to death. Familiarity with AE may prompt appropriate antibody screening, particularly in cases of refractory seizure disorders. Early investigation and proper management of AE cases may help to prevent parenchymal and neurologic deterioration in these patients.

LanguageEnglish (US)
Article number20170869
JournalBritish Journal of Radiology
Volume92
Issue number1093
DOIs
StatePublished - Jan 1 2019

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Pets
Epilepsy
Seizures
Limbic System
Antibodies
Brain Diseases
Sclerosis
Basal Ganglia
Autoantibodies
Cerebellum
Nervous System
Brain Stem
Atrophy
Edema
Antigens
Therapeutics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Guerin, J., Watson, R. E., Carr, C., Liebo, G. B., & Kotsenas, A. L. (2019). Autoimmune epilepsy: Findings on MRi and FDG-Pet. British Journal of Radiology, 92(1093), [20170869]. https://doi.org/10.1259/bjr.20170869

Autoimmune epilepsy : Findings on MRi and FDG-Pet. / Guerin, Julie; Watson, Robert E.; Carr, Carrie; Liebo, Greta B.; Kotsenas, Amy L.

In: British Journal of Radiology, Vol. 92, No. 1093, 20170869, 01.01.2019.

Research output: Contribution to journalReview article

Guerin, J, Watson, RE, Carr, C, Liebo, GB & Kotsenas, AL 2019, 'Autoimmune epilepsy: Findings on MRi and FDG-Pet', British Journal of Radiology, vol. 92, no. 1093, 20170869. https://doi.org/10.1259/bjr.20170869
Guerin, Julie ; Watson, Robert E. ; Carr, Carrie ; Liebo, Greta B. ; Kotsenas, Amy L. / Autoimmune epilepsy : Findings on MRi and FDG-Pet. In: British Journal of Radiology. 2019 ; Vol. 92, No. 1093.
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