Autoimmune Epilepsy - Causes, Risk Factors, and Treatment

Introduction

The immune system defends the body against illness and infection by fighting off invaders like viruses and bacteria. Since germs are not a part of the body, the immune system can identify them and eliminates them. In autoimmune diseases, the immune system unintentionally targets healthy cells in the organs and tissues. Autoimmune disorders frequently run in families. Some individuals may be predisposed to issues due to particular genes. If a person already has the genes for an autoimmune disease, viruses, chemicals, and other environmental factors may cause it to manifest. When the brain activity is abnormal, seizures or periods of strange behavior, sensations, and occasionally loss of awareness result. This condition is known as epilepsy, which is a central nervous system (neurological) disorder.

What Is Autoimmune Epilepsy?

Autoimmune epilepsy, in simple words, is a seizure disorder in which a pathogenic antibody specific to the nervous system is present and may cause seizures. There is a presence of actively circulating antibodies against the nervous system, which points to an autoimmune origin of this condition. Antigens inside or on the surface of neural cells (cells in the brain) may be the target of these antibodies.

What Are the Causes of Autoimmune Epilepsy?

The causes of autoimmune epilepsy are listed below:

• Any medication has the potential to generate an autoimmune drug reaction.

• The autoimmune disease runs in the family. Certain illnesses are inherited; they run in families.

• Smoking.

• Having already developed an autoimmune disease. There is a likelihood of getting another one.

• Exposure to toxic substances.

• Autoimmune disease patients are overwhelmingly female (78 percent).

• Obesity.

• Infections.

What Are the Risk Factors of Autoimmune Epilepsy?

The risk factors of autoimmune epilepsy include those who have:

• A past diagnosis of another autoimmune disorder like lupus (immune system attack causing organ inflammation).

• A history of cancer.

• A close relative (parent, sibling, or child) who suffers from an autoimmune condition.

• A sudden and severe increase in seizures is another sign that epilepsy may be autoimmune in origin.

What Are the Symptoms of Autoimmune Epilepsy?

• Seizures occur multiple times throughout the day.

• Occurrence of focal seizures (seizures that start in one area of the brain and spread to other areas).

• Occurrence of facial brachial dystonic seizures (FBDS), also known as facial brachial dystonic epilepsy, are seizures that affect the same side of the face and arm on the same side of the body.

• Seizure medications do not effectively control these seizures.

• People may experience memory issues, personality changes, and changes in mood or behavior (hallucinations, depression, or paranoia).

Seek emergency medical help in case of the following:

• A seizure last five minutes or longer.

• A person is not regaining consciousness.

• One seizure is followed immediately by another.

• Seizures happen more frequently and closer together.

• It becomes difficult to breathe, or the person seems to be choking.

How Is Autoimmune Epilepsy Diagnosed?

The diagnosis of autoimmune epilepsy is made in the ways listed below:

• Neurological Assessment - The doctor may perform tests to identify the type of epilepsy and diagnose the condition and assess the behavior, motor skills, mental function, and other aspects.

• Blood Test - In order to look for infections, genetic disorders, or other conditions that might be linked to seizures, the doctor may request a sample of blood.

• Electroencephalogram (EEG) -The procedure used to identify epilepsy is an electroencephalogram. With the help of a paste-like substance or cap, electrodes are affixed to the scalp for this test. The electrodes capture the brain's electrical activity. Even when not having a seizure, epilepsy patients frequently experience changes in their typical pattern of brain waves. When performing an EEG, awake or asleep, the doctor may videotape the procedure in order to document any seizure episodes. The doctor may be able to identify the type of seizures.

• Computer Tomography (CT) Scan - X-rays are used in a CT scan to produce cross-sectional images of the brain. CT scans can detect tumors, bleeding, and cysts, as well as other structural abnormalities in the brain that may be the root cause of seizures.

• Magnetic Resonance Imaging (MRI) - The MRI scan uses magnetic resonance to produce a detailed brain image; an MRI uses strong magnets and radio waves. The doctor might be able to identify brain lesions or other anomalies that could be the root cause of seizures.

• Positron Emission Tomography (PET) Scan - A small amount of low-dose radioactive material is injected into a vein during a PET scan to help visualize the brain's metabolic activity and find anomalies. Low metabolic brain regions may be a sign of seizure activity.

• Examinations of the Brain - Doctors evaluate the thinking, memory, and communication abilities during these tests. The test results assist doctors in identifying the parts of the brain that are affected.

What Is the Treatment of Autoimmune Epilepsy?

Medication is typically the first line of treatment for epilepsy for doctors. Doctors may suggest surgery or an alternative form of treatment if medications are unable to manage the condition.

• Medication - The majority of people with epilepsy can go seizure-free by taking one anti-seizure medication, also known as an anti-epileptic drug. By using a combination of medications, some people may be able to lessen the frequency and severity of their seizures. In the case of autoimmune epilepsy, immunosuppressants and corticosteroids (Prednisone or Methylprednisolone) may be given to reduce the immune system's attack on the body.

• Surgery - Surgery may be an option if medication-only treatment is ineffective in controlling seizures. The part of the brain that is causing seizures is removed during epilepsy surgery.

• Vagus Nerve Stimulation - In vagus nerve (nerve carrying signals from organs to the brain) stimulation, a device called a vagus nerve stimulator is implanted beneath the chest skin, much like a heart pacemaker. The neck's vagus nerve is attached to wires coming from the stimulator. The battery-operated gadget delivers brief electrical shocks to the brain via the vagus nerve. The mechanism by which this prevents seizures is unclear, but it typically reduces seizures by 20 to 40 %.

• Ketogenic Diet - Following a strict diet that is high in fats and low in carbohydrates has helped some epileptic children experience fewer seizures. The body uses fats for energy instead of carbohydrates when following this diet, known as the ketogenic diet. Some kids might be able to discontinue the ketogenic diet after a few years and continue to have no seizures, provided they do so under the close supervision of their doctors.

• Deep-Brain Stimulation - Deep-brain stimulation involves the surgical implantation of electrodes into a particular area of the brain, usually the thalamus. A generator that is implanted in the chest is connected to the electrodes. The generator periodically delivers timed electrical pulses to the brain, which may lessen the seizure frequency. When medication for seizures does not work, deep brain stimulation is frequently used.

• Sensitive Neurostimulation - These pacemaker-like, implantable devices can significantly lower the frequency of seizures. When a seizure begins, these responsive stimulation devices analyze brain activity patterns to identify it and deliver a drug or electrical charge to stop the seizure before it impairs function. According to research, this treatment can prevent seizures permanently and has few side effects.

What Are the Complications of Autoimmune Epilepsy?

Autoimmune epilepsy can have the following complication:

• Learning difficulties.

• A seizure can cause aspiration pneumonia if the sufferer inhales food or saliva into their lungs.

• Injury from slips, knocks, self-inflicted bites, driving, or operating machinery while having a seizure.

• Stroke or other types of permanent brain injury.

• Medication side effects.

How to Prevent Autoimmune Epilepsy?

Autoimmune epilepsy can be prevented in the following ways:

• Prevent traumatic brain injuries.

• Avoid getting infections.

• Eat properly washed and cooked food.

• Do deworming of the body regularly.

• Do exercise regularly.

• Eat a well-balanced diet.

• Avoid alcohol and smoking.

Conclusion

Epilepsy, also referred to as seizure disorder, is a common brain disorder that results in frequent seizures. Numerous conditions that have an impact on the brain can lead to epilepsy. Examples include stroke, head injury, complications during childbirth, infections (like meningitis or cysticercosis), and some genetic disorders. Frequently, no clear reason can be identified. Epilepsy that is caused due to the immune system attacking the body is called autoimmune epilepsy. People having autoimmune epilepsy have seizures several times a day. Immunotherapy is very successful in treating autoimmune epilepsy. The inflammation in the brain can be treated with immunotherapy. Steroids like Prednisone or Methylprednisolone, administered orally or intravenously (IV), are frequently used as a treatment. Also possible is the intravenous administration of immunoglobulin (IVIg).