epilepsiaEpilepsy and paroxysmal conditionsЭпилепсия и пароксизмальные состояния2077-83332311-4088IRBIS LLC10.17749/2077-8333/epi.par.con.2025.215epilepsia-1186Research ArticleORIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИBilateral tonic-clonic seizures and status epilepticus in autoimmune encephalitisПриступы с билатеральными тонико-клоническими судорогами и эпилептический статус при аутоиммунном энцефалитеhttps://orcid.org/0000-0002-7682-6672МаксимоваМ. Ю.MaximovaM. Yu.

Максимова Марина Юрьевна, д.м.н., проф.  

WoS Researcher ID: C-7408-2012. Scopus Author ID: 7003900736 

Волоколамское ш., д. 80, Москва 125367

Marina Yu. Maximova, Dr. Sci. Med., Prof.  

WoS Researcher ID: C-7408-2012. Scopus Author ID: 7003900736 

80 Volokolamskoe Shosse, Moscow 125367 

https://orcid.org/0000-0003-3307-8472ГоловнёваЕ. А.GolovnevaE. A.

Головнёва Евгения Алексеевна 

Scopus Author ID: 57985980600

Волоколамское ш., д. 80, Москва 125367

Evgenia A. Golovneva  

Scopus Author ID: 57985980600

80 Volokolamskoe Shosse, Moscow 125367 

ev.batishewa@yandex.ruhttps://orcid.org/0000-0002-6381-2925БрутянА. Г.BroutianA. G.

Брутян Амаяк Грачевич, к.м.н.  

Scopus Author ID: 57214245733 

Волоколамское ш., д. 80, Москва 125367

Amayak G. Broutian, PhD 

Scopus Author ID: 57214245733

80 Volokolamskoe Shosse, Moscow 125367 

https://orcid.org/0000-0001-5442-0877ЧекановаЕ. О.ChekanovaE. O.

Чеканова Екатерина Олеговна 

Scopus Author ID: 57214245733 

Волоколамское ш., д. 80, Москва 125367

Ekaterina O. Chekanova 

80 Volokolamskoe Shosse, Moscow 125367 

https://orcid.org/0000-0002-1072-9968ЗахароваМ. Н.ZakharovaM. N.

Захарова Мария Николаевна, д.м.н., проф.  

Scopus Author ID: 57214245733 

Волоколамское ш., д. 80, Москва 125367

Maria N. Zakharova, Dr. Sci. Med., Prof.  

Scopus Author ID: 57214245733 

80 Volokolamskoe Shosse, Moscow 125367 

Федеральное государственное бюджетное научное учреждение «Научный центр неврологии»РоссияResearch Center of NeurologyRussian Federation2025020520251714047Copyright © Maximova M.Y., Golovneva E.A., Broutian A.G., Chekanova E.O., Zakharova M.N., 20252025Максимова М.Ю., Головнёва Е.А., Брутян А.Г., Чеканова Е.О., Захарова М.Н.Maximova M.Y., Golovneva E.A., Broutian A.G., Chekanova E.O., Zakharova M.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.epilepsia.su/jour/article/view/1186Background

Background. Epileptic seizures are involved in the diagnostic criteria for autoimmune encephalitis (AE). In this regard, timing of onset of focal-to-bilateral tonic-clonic seizure (BTCS) transition and status epilepticus (SE) in AE is understudied.

Objective

Objective: to compare the timing of onset for focal-to-BTCS and SE during AE.

Material and methods

Material and methods. Examination of patients with AE included collecting patient history, conducting blood and cerebrospinal fluid tests, magnetic resonance imaging, and long-term electroencephalographic video-monitoring. Out of 41 examined patients, 22 (54%) were diagnosed with “suspected AE” and 19 (46%) patients had “verified AE”. Focal-to-BTCS were noted in patient history of 36 (88%) subjects, including subsequent SE observed in 12 (29%) cases.

Results

Results. A single focal-to-BTCS/SE was the first AE symptom found in 8 (22%) patients, including 1 patient bearing antibodies against glutamate decarboxylase 65 (GAD65). In 8 (22%) cases, AE manifested with focal seizures, whereas focal-to-BTCS and/or SE developed later. This type of AE course was most commonly observed in patients with anti-GAD65 antibody-positive encephalitis (4 out of 9 cases). Focal-to-BTCS and SE developed only at disease onset and during exacerbations of the immune process in 5 (14%) patients, 2 of whom carried anti-myelin oligodendrocyte glycoprotein antibodies.

Conclusion

Conclusion. Focal-to-BTCS and SE most often emerge at AE onset. Anti-GAD65 antibody-positive encephalitis is manifested by long-lasting drug-resistant epilepsy with late onset of focal-to-BTCS and SE. In case of anti-GAD65 antibody-positive AE, epileptic seizures occur only at disease onset.

Актуальность

Актуальность. Эпилептические приступы входят в диагностические критерии аутоиммунных энцефалитов (АЭ). Сроки развития эпилептических приступов с переходом в билатеральные тонико-клонические судороги (БТКС) и эпилептического статуса (ЭС) при АЭ изучены недостаточно.

Цель

Цель: сопоставить сроки развития эпилептических приступов с БТКС и ЭС с течением АЭ.

Материал и методы

Материал и методы. Проведено обследование больных с АЭ, включавшее сбор анамнеза, лабораторное исследование крови и цереброспинальной жидкости, магнитно-резонансную томографию, продолженный электроэнцефалографический видеомониторинг. Обследован 41 пациент: 22 (54%) с диагнозом «возможный АЭ» и 19 (46%) с диагнозом «достоверный АЭ». У 36 (88%) больных в анамнезе отмечались эпилептические приступы с переходом в БТКС, в т.ч. с последующим развитием ЭС в 12 (29%) случаях.

Результаты

Результаты. У 8 (22%) больных, включая 1 пациента с антителами к глутаматдекарбоксилазе (англ. glutamate decarboxylase 65, GAD65), единичный приступ с БТКС/ЭС являлся первым симптомом АЭ. В 8 (22%) наблюдениях АЭ манифестировал с фокальных приступов, приступы с БТКС и/или ЭС присоединялись позже. Этот вариант течения АЭ чаще всего наблюдался среди пациентов с анти-GAD65-ассоциированным энцефалитом (в 4 из 9 случаев). У 5 (14%) больных, у 2 из которых обнаружены антитела к миелиновому олигодендроцитарному гликопротеину, приступы с БТКС и ЭС наблюдались только в дебюте и при обострениях иммунного процесса.

Заключение

Заключение. Эпилептические приступы с БТКС и ЭС наиболее часто возникают в дебюте АЭ. Анти-GAD65- ассоциированный энцефалит проявляется в виде длительно текущей фармакорезистентной эпилепсии с поздним присоединением приступов с БТКС и ЭС. В редких случаях АЭ с антителами к GAD65 эпилептические приступы случаются только в дебюте заболевания.

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The authors declare that there are no conflicts of interest present.