2019 Volume 36 Issue 4 Pages 447-451
The international league against epilepsy (ILAE) classification of the epilepsy was updated in 2017. An etiological diagnosis was considered in this classification, i.e. structural, genetic, infection, metabolic, immune and unknown. The concept of immune epilepsy is that it results directly from an immune disorder in which seizures are a core symptom of the disorder. An immune etiology was conceptualized as where there is evidence of autoimmune–mediated central nervous system inflammation. Although autoimmune encephalitis has been under–diagnosed because of the difficulty to find responsible antibodies, increasing number of antibodies have been recognized as the causes of autoimmune encephalitis. Epileptic seizures evoked by autoimmune encephalitis should be treated by immunotherapies instead of conventional antiepileptic drug therapies. The clinical features of autoimmune–mediated encephalitis frequently manifest those of limbic encephalitis, since amount of patients often encounter complex partial seizures (seizures with loss of awareness) accompanied with memory disturbance, abnormal behaviors and psychosis. In case of progressive psychosis or neurological disorder with undetermined etiology, we should pay attention to the possibility of immune–mediated encephalitis and consider the indication of immunotherapy. The representative antibodies are anti–NMDA (N–methyl–d–aspartate) receptor or anti–VGKC (voltage–gated potassium channel), which are considered to have direct relation with induction of epileptic seizure. Therefore, it would be necessary to elucidate the mechanism how autoantibodies induce epilepsy or how immunotherapy is effective.
