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The association between systemic autoimmune disorders and epilepsy and its clinical implications.

系统性自身免疫性疾病与癫痫的关系及其临床意义.

  • 影响因子:7.52
  • DOI:10.1093/brain/awaa362
  • 作者列表:"Steriade C","Titulaer MJ","Vezzani A","Sander JW","Thijs RD
  • 发表时间:2021-03-03
Abstract

:Systemic autoimmune disorders occur more frequently in patients with epilepsy than in the general population, suggesting shared disease mechanisms. The risk of epilepsy is elevated across the spectrum of systemic autoimmune disorders but is highest in systemic lupus erythematosus and type 1 diabetes mellitus. Vascular and metabolic factors are the most important mediators between systemic autoimmune disorders and epilepsy. Systemic immune dysfunction can also affect neuronal excitability, not only through innate immune activation and blood-brain barrier dysfunction in most epilepsies but also adaptive immunity in autoimmune encephalitis. The presence of systemic autoimmune disorders in subjects with acute seizures warrants evaluation for infectious, vascular, toxic and metabolic causes of acute symptomatic seizures, but clinical signs of autoimmune encephalitis should not be missed. Immunosuppressive medications may have antiseizure properties and trigger certain drug interactions with antiseizure treatments. A better understanding of mechanisms underlying the co-existence of epilepsy and systemic autoimmune disorders is needed to guide new antiseizure and anti-epileptogenic treatments. This review aims to summarize the epidemiological evidence for systemic autoimmune disorders as comorbidities of epilepsy, explore potential immune and non-immune mechanisms, and provide practical implications on diagnostic and therapeutic approach to epilepsy in those with comorbid systemic autoimmune disorders.

摘要

: 系统性自身免疫性疾病在癫痫患者中比在普通人群中更频繁地发生,提示共同的疾病机制。癫痫的风险在全身性自身免疫性疾病的范围内升高,但在系统性红斑狼疮和1型糖尿病中最高。血管和代谢因素是系统性自身免疫性疾病和癫痫之间最重要的介质。全身性免疫功能障碍也可影响神经元兴奋性,不仅通过大多数癫痫的先天免疫激活和血脑屏障功能障碍,而且通过自身免疫性脑炎的适应性免疫。患有急性癫痫发作的受试者中存在全身性自身免疫性疾病需要评估急性症状性癫痫发作的感染性、血管性、中毒性和代谢性原因,但不应错过自身免疫性脑炎的临床症状。免疫抑制药物可能具有抗癫痫发作特性,并引发与抗癫痫发作治疗的某些药物相互作用。需要更好地理解癫痫和系统性自身免疫性疾病共存的机制,以指导新的抗癫痫发作和抗癫痫治疗。本综述旨在总结系统性自身免疫性疾病作为癫痫合并症的流行病学证据,探讨潜在的免疫和非免疫机制,并为合并系统性自身免疫性疾病的癫痫的诊断和治疗方法提供实际意义。

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DOI:10.1007/s11033-021-06299-9
作者列表:["Louvrier A","Terranova L","Meyer C","Meyer F","Euvrard E","Kroemer M","Rolin G"]

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