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Clinical Cases and Reviews in Epilepsy

Psychiatric symptoms as early and sole manifestation heralding autoimmune epilepsy: case series and proposal of the “SAPIENCE” criteria for early identification and treatment

Brief report/Clinical case, 33 - 39
doi: 10.11138/ccre/2016.1.1.033
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Abstract
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Objective: to describe clinical, electroencephalographic and radiological features of a subset of patients with autoimmune epilepsy who present initially with a sole psychiatric symptomatology.
Methods: retrospective case series of patients with presumed autoimmune epilepsy admitted to our Institutions between January 1, 2012, and January 1, 2015. The following inclusion criteria were applied: acute or subacute onset (< 3 months) of seizures; psychiatric or behavioural symptomatology as presenting feature; CSF evidence of inflammation; MRI evidence of inflammation; anti-neural antibody detected in patients’ serum, CSF or both. Criterion of exclusion was the presence of another cause that could explain the patient symptoms.
Results: 11 patients were included in the present study. The majority of them were young and female. Neural autoantibodies included NMDAR-Abs in four patients, GAD65-Ab and Ma2-Ab in one patient each; five patients were seronegative. Typical
MRI alterations were present in 82% of cases. Inflammatory CSF was present in 64%. The presenting psychiatric symptoms were catatonia (27%), psychosis (18%), anxiety disorder (18%) and other symptoms (36%), including a depressive episode.
Focal seizures were the most common seizure type. Four patients (36%) developed status epilepticus.
After immunotherapy, three patients had a complete recovery, four showed an improvement and one patient died.
Conclusion: we proposed the SAPIENCE criteria (S: seizures of focal onset; A: associated autoimmune diseases; P: psychiatric history unremarkable; I: inflammatory changes on MRI/CSF; E: EEG abnormalities; N: new onset/subacute onset; C: cancer; E: encephalitis) for early identification and treatment of patients with autoimmune epilepsy.

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