| Abstract [eng] |
Aim: To analyze demographic, clinical, laboratory, instrumental and radiological data of patients who experienced seizures and had mesiotemporal changes on MRI and to evaluate the prevalence of autoimmune encephalitis (AE) and epilepsy in this group. Methods: A retrospective analysis was performed on anonymized data of patients treated at Vilnius University Hospital Santaros Clinics, who presented with seizures and had hippocampal and/or amygdala (CA) edema and/or increased signal intensity on T2-weighted MRI. Patients were divided into AE positive and negative groups. Results: 20 patients were analyzed (9 males, 45%), mean age 43.35 ±18.32 years. AE was diagnosed in 40% (n=8), with 50% of the being seropositive. AE was more often found in younger males (mean age 39.4 years), especially those with oncological history (80%, 4/5). Among AE cases, 87.5% were diagnosed with epilepsy (50% autoimmune, 50% structural, 12.5% drug-resistant, 12.5% temporal). Symptoms like perceptual disturbances (75%), cognitive decline (50%), déjà vu (25%) and generalized tonic-clonic seizures (87.5%) were more frequent in AE. Autoantibody testing was performed in 70% of patients (serum) and only 35% in CSF. AE patients had higher pleocytosis (mean 68 cells/µL) and protein (0.404 g/L) in CSF. CA edema or hyperintensity was detected in 75% of both groups. Hippocampal edema was more frequent in AE (62.5%), as well as unilateral MRI findings (87.5%). Treatment response was better in seronegative and non-AE patients; seizures increased in seropositive AE cases. Two AE patients discontinued treatment (25%), one experienced relapse with early hippocampal sclerosis. Conclusions: AE was more frequently diagnosed in younger males with cancer history and neuropsychiatric symptoms, while TLE dominated in older females with speech and focal motor symptoms. Unilateral hippocampal edema may indicate active inflammation and support AE diagnosis. Hippocampal hyperintensity, more typical in AE-negative cases, may reflect chronic changes, suggesting the need for broader autoimmune screening in epilepsy with structural mesiotemporal changes. Keywords: autoimmune encephalitis; epilepsy; hippocampal edema. |
