A type of epilepsy caused by antibodies that mistakenly attack brain cells is called autoimmune epilepsy. It may also occur with other autoimmune disorders (such as autoimmune encephalitis). Sometimes, this condition is called autoimmune-associated epilepsy and acute symptomatic seizures secondary to autoimmune encephalitis.
In normal circumstances, the immune system produces antibodies that help protect the body from bacteria, viruses, and other germs that cause infections. However, in people with autoimmune epilepsy, these antibodies attack healthy cells of the brain. As a result, it leads to swelling (inflammation) of the brain and seizures.
While antiseizure medications are not so effective, doctors often recommend immunotherapy to reduce inflammation caused by the disease. This therapy helps improve symptoms (such as seizures). Some people may get rid of seizures completely with treatment, but others may continue to have this symptom even after treatment.
Symptoms
Usually, the symptoms of this condition appear after an illness with a fever. Moreover, seizures may appear suddenly. Check below some types of seizures that may happen:
- Focal seizures – This is the most common type of seizures that occur in people with autoimmune epilepsy. It may cause a change or loss of awareness. However, other types of seizures do not cause changes in awareness. Other symptoms of focal seizures include vision changes and nausea.
- Faciobrachial dystonic seizures – This type of seizure usually causes involuntary muscle contractions in one side of the face and arm.
Moreover, seizures may happen multiple times per day, do not go away with antiseizure medications, or last more than 5 minutes, which is considered a medical emergency (also known as a status epilepticus).
Check below some symptoms that people with autoimmune epilepsy often experience:
- Memory problems
- Trouble with thinking
- Personality or behavioral changes
- Involuntary movements
- Irregular eye movements
- Changes in certain automatic functions (including blood pressure, heart rhythm, and others)
If you or a loved person experiences a seizure that lasts more than 5 minutes, go to the nearest emergency room immediately or call 911 in the U.S.
Causes
This health condition happens when the immune system mistakenly attacks healthy cells in the brain and causes seizures. According to recent research, epilepsy can be an autoimmune disease. Check below some autoimmune epilepsy causes:
- Autoimmune encephalitis – A group of conditions that cause inflammation in the brain is called autoimmune encephalitis. Moreover, it is the most common cause of autoimmune epilepsy. Some types of autoimmune encephalitis are linked with autoimmune epilepsy and antibodies that attack NMDA receptors (including LGI1, CASPR2, and GAD65).
- Rasmussen syndrome – In people with this syndrome, T cells cause swelling (inflammation) in the brain, which leads to seizures. Those who suffer from both Rasmussen syndrome and autoimmune epilepsy may have seizures even after treatment.
- Cancer – In some cases, people develop autoimmune epilepsy due to some types of cancer. Therefore, it is called paraneoplastic syndrome, and it may trigger epilepsy.
Risk Factors
Generally, the risk of autoimmune epilepsy is low, but it may happen in both children and adults. Check below some factors that could elevate your risk of developing autoimmune epilepsy. Examples include:
- Other autoimmune disorders (such as rheumatoid arthritis, lupus, Hashimoto’s thyroiditis, Crohn’s disease, ulcerative colitis, Graves’ disease, and others)
- A medical history of cancer
- A family history of autoimmune disorders – For example, if you have a parent or sibling with an autoimmune disorder, your risk of developing it significantly increases.
What Are The Potential Complications of Autoimmune Epilepsy?
This condition may cause a serious complication. It is a seizure that lasts more than 5 minutes. This complication is a medical emergency, and it is called status epilepticus.
How to Prevent Autoimmune Epilepsy?
There is no way to prevent this type of epilepsy. However, regular cancer screenings may prevent autoimmune epilepsy that is caused by some types of cancer. For more details, discuss it with your healthcare provider.
Diagnosis
Physicians usually diagnose this condition based on the physical examination and symptoms. They may also perform some tests to confirm the condition and exclude others that cause similar symptoms. Check some examples below:
- Electroencephalogram (also known as EEG) – This test is used to measure the electrical activity of the brain. It may show seizures and help doctors diagnose autoimmune epilepsy.
- Imaging tests – Doctors may perform an imaging test to get detailed images of the brain. They often perform an FDG (fluorodeoxyglucose) PET (positron emission tomography) scan to get clues about the disease. This test may help doctors identify the exact cause of autoimmune epilepsy (such as autoimmune encephalitis).
- Laboratory tests – This involves blood tests to check for antibodies that attack healthy brain cells. Additionally, doctors may perform a lumbar puncture to get a small sample of cerebrospinal fluid for testing. Sometimes, these tests cannot identify antibodies despite the patient having autoimmune epilepsy.
Treatment
The treatment recommended for people with autoimmune epilepsy is different because it depends on several factors. These include the severity and cause of the condition, overall health, your age, and others. Sometimes, doctors may prescribe cancer treatments (such as radiation therapy and chemotherapy) if autoimmune epilepsy is caused by cancer. Check below some treatments usually recommended by doctors for people with this condition:
Immunotherapy
Commonly, this is the primary treatment for people with autoimmune epilepsy and autoimmune encephalitis. It helps reduce inflammation and lessen symptoms. For example:
- High-dose corticosteroids – This medicine is often given to patients intravenously (IV) for 2-5 days. Physicians usually prescribe Methylprednisolone. After 5 days of treatment, doctors may prescribe oral steroids (such as Prednisone).
- Immunoglobulin – This medication is also given intravenously in the arm for up to 5 days. If you respond to treatment, the medicine should be taken for several weeks, but gradually reducing the dose.
Plasma Exchange
This treatment helps get rid of antibodies that mistakenly attack healthy cells of the brain. During this procedure, doctors will separate the liquid part of the blood from blood cells and then return it to the body. Therefore, the body will start to produce more plasma.
Antiseizure Medications
While these medications are not as effective as immunotherapy, they still play an important role in autoimmune epilepsy treatment. If you get rid of seizures after immunotherapy, doctors will reduce antiseizure medicine to make sure seizures do not return.
In addition, people who experience memory problems, slurred speech, or insomnia may need occupational and speech therapy that can improve these symptoms. Consult with your doctor for more details.
Surgery
Sometimes, people may develop autoimmune epilepsy due to Rasmussen syndrome. This condition often affects children and cannot be treated with medications. Thus, such children need brain surgery to treat it.
Frequently Asked Questions
When should you suspect autoimmune epilepsy?
Check below the most common symptoms of autoimmune epilepsy:
- Frequent seizures
- Mood swings
- Memory problems
- Personality changes
Immediately contact a healthcare professional if any of the previous symptoms occur.
How rare is autoimmune epilepsy?
Approximately 1 to 7 out of 20 (5% to 35%) people with new seizures may have other autoimmune conditions. These include Hashimoto’s thyroiditis, Graves’ disease, Crohn’s disease, ulcerative colitis, systemic lupus erythematosus, rheumatoid arthritis, and others.
What disease mimics epilepsy?
There are some conditions that can be mistaken for autoimmune epilepsy. These include:
- Vasovagal syncope
- Reflex anoxic seizures
- Breath-holding attacks
- Hyperventilation syncope
- Compulsive Valsalva
- Neurological syncope
- Imposed upper airway obstruction
- Orthostatic intolerance
This article does not contain all possible conditions that can be mistaken for autoimmune epilepsy. Ask your healthcare provider if you have additional questions.
