Palabras clave
epilepsia de nuevo diagnóstico
autoanticuerpos neuronales
complejo de canales de potasio dependientes de voltaje
ácido glutámico descarboxilasa
receptor NMDA
Cómo citar
Resumen
Introducción: La epilepsia autoinmune es poco reconocida y se desconoce su incidencia. Objetivo: Determinar la incidencia de autoanticuerpos neuronales en pacientes con epilepsia de etiología desconocida. Materiales y métodos: Se realizó un estudio observacional, longitudinal, prospectivo y analítico evaluando la presencia de autoanticuerpos para encefalitis autoinmune, ácido glutámico descarboxilasa-65 y onconeuronales en suero y líquido cefalorraquídeo, en pacientes consecutivos con epilepsia de etiología desconocida. Resultados: Se incluyeron 60 pacientes y 80 controles (30 sanos, 30 con esclerosis múltiple, 10 con lupus eritematoso sistémico, 10 con síndrome de Sjögren) para detectar anticuerpos neuronales. Un total de 28/60 (47%) pacientes con epilepsia tenía anticuerpos contra: receptor de Nmetil- D-aspartato, proteína 2 asociada a contactina, proteína 1 inactivada de glioma rica en leucina y descarboxilasa del ácido glutámico, una incidencia que fue significativamente mayor (p < 0,001) que en la cohorte de control combinada. Pacientes y controles fueron negativos para anticuerpos onconeuronales, excepto 6 casos de epilepsia, 1 de esclerosis múltiple y 3 de lupus con a- descarboxilasa del ácido glutámico positivo por IIF-TBA e inmunotransferencia. No se encontró diferencia en la incidencia de los autoanticuerpos estudiados entre hombres y mujeres con epilepsia. La aparición de autoanticuerpos positivos en pacientes con epilepsias focales fue significativamente mayor en comparación con pacientes con epilepsia generalizada (p < 0,01). Conclusiones: Se han encontrado anticuerpos contra receptores (NMDAR), proteínas asociadas con VGKC (LGI1, CASPR2) y anticuerpos dirigidos a antígenos intracelulares (GAD65) en el suero y líquido cefalorraquídeo de pacientes con epilepsia, lo que sugiere una etiología autoinmune.
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