An increasingly recognized cause for intractable seizures is autoimmune disease. Autoimmune epilepsy is a form of autoimmune encephalitis, encephalopathy or limbic encephalitis, in which seizures are the primary symptom.

Autoimmune epilepsy is important to diagnose because patients with this condition usually have seizures that do not completely respond to standard anti-seizure medications, but often respond to immune therapies. Some examples of immune therapies include: corticosteroids, intravenous immune globulin, plasma exchange or other treatments that suppress the immune system.

In a study presented in JAMA Neurology, Dubey and colleagues investigated risk factors that may be predictive of an autoimmune cause for epilepsy. These risk factors included:

• New onset seizures or progressive mental status changes
• Neuropsychiatric symptoms
• Autonomic instability
• A viral prodrome (early symptom indicating illness)
• Dystonic limb or face posturing
• Seizures that do not respond to two anti-seizure medications
• Inflammatory cerebrospinal fluid
• Limbic encephalitic changes on magnetic resonance imaging (MRI)
• Presence of systemic cancer