OBJECTIVE There is a growing recognition of immune-mediated causes in patients with focal drug-resistant epilepsy (DRE); however, they are not systematically assessed in the pre-surgical diagnostic workup. Early diagnosis and initiation of immunotherapy is associated with a favorable outcome in immune-mediated seizures. Patients with refractory focal epilepsy with neuronal antibodies (Abs) tend to have a worse surgical prognosis when compared to other etiologies. METHODS We studied the prevalence of serum Abs in patients ≥18 years of age with DRE of unknown cause before surgery. We proposed and calculated a clinical APES (Antibody Prevalence in Epilepsy before Surgery) score for each subject, which was modified based on Dubey's previously published APE2 score. RESULTS`: A total of 335 patients were screened and 86 subjects were included in final analysis. The mean age at the time of recruitment was 44.84 ± 14.86 years, with age at seizure onset 30.89 ± 19.88 years. There were no significant differences among baseline clinical features between retrospective and prospective sub-cohorts. The prevalence of at least one positive Ab was 33.72%, and central nervous system (CNS)-specific Abs was 8.14%. APES score ≥4 showed slightly better overall prediction (area under the curve [AUC]: 0.84 vs 0.74) and higher sensitivity (100% vs 71.4%), with slightly lower but similar specificity (44.3% vs 49.4%), when compared to APE2 score ≥4. For subjects who had available positron emission tomography (PET) results and all components of APES score (n = 60), the sensitivity of APES score ≥4 yielded a similar prediction potential with an AUC of 0.80. SIGNIFICANCE Our findings provide persuasive evidence that a subset of patients with focal DRE have potentially immune-mediated causes. We propose an APES score to help identify patients who may benefit from a workup for immune etiologies during the pre-surgical evaluation for focal refractory epilepsy with unknown cause.

中文翻译：

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抗药性局灶性癫痫手术前癫痫 (APES) 中的抗体患病率

目的 局灶性耐药性癫痫 (DRE) 患者中免疫介导的病因得到越来越多的认识；然而，它们并未在术前诊断检查中进行系统评估。免疫介导的癫痫发作的早期诊断和启动与有利的结果相关。与其他病因相比，患有神经元抗体 (Abs) 的难治性局灶性癫痫患者的手术预后往往更差。方法 我们研究了 18 岁以上不明原因 DRE 患者术前血清 Abs 的患病率。我们提出并计算了每个受试者的临床 APES（手术前癫痫抗体患病率）评分，该评分根据 Dubey 先前公布的 APE2 评分进行了修改。结果`：共筛选了 335 名患者，最终分析包括 86 名受试者。招募时的平均年龄为 44.84 ± 14.86 岁，癫痫发作的年龄为 30.89 ± 19.88 岁。回顾性和前瞻性子队列的基线临床特征没有显着差异。至少一种阳性抗体的患病率为 33.72%，中枢神经系统 (CNS) 特异性抗体的患病率为 8.14%。APES 评分 ≥ 4 显示总体预测略好（曲线下面积 [AUC]：0.84 对 0.74）和更高的敏感性（100% 对 71.4%），与相比略低但相似的特异性（44.3% 对 49.4%） APE2 评分≥4。对于具有可用正电子发射断层扫描 (PET) 结果和 APES 评分的所有组成部分 (n = 60) 的受试者，APES 评分≥4 的敏感性产生了类似的预测潜力，AUC 为 0.80。意义我们的研究结果提供了有说服力的证据，表明一部分局灶性 DRE 患者具有潜在的免疫介导原因。我们提出了一个 APES 评分，以帮助识别可能受益于不明原因局灶性难治性癫痫的术前评估期间免疫病因检查的患者。