Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABABR Antibodies: Implications for Return to Driving

Anna Rada; Anne Hagemann; Charlotte Aaberg Poulsen; Tobias Baumgartner; Timea Berki; Morten Blaabjerg; Juliette Brenner; Jeffrey W. Britton; Andrew Christiana; Nicolás L. Ciano-Petersen; Yvette Crijnen; Martin Elišák; Antonio Farina; Alec R. Friedman; Zsófia Hayden; Julien Hébert; Martin Holtkamp; Zhen Hong; Jerome Honnorat; Maria Ilyas-Feldmann; Sarosh R. Irani; Stjepana Kovac; Petr Marusic; Sergio Muñiz-Castrillo; Sudarshini Ramanathan; Kelsey M. Smith; Claude Steriade; Christine Strippel; Rainer Surges; Maarten J. Titulaer; Christopher E. Uy; Juna M. De Vries; Christian G. Bien; Ulrich Specht

doi:10.1212/NXI.0000000000200225

Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABA_BR Antibodies: Implications for Return to Driving

Anna Rada^*, Anne Hagemann, Charlotte Aaberg Poulsen, Tobias Baumgartner, Timea Berki, Morten Blaabjerg, Juliette Brenner, Jeffrey W. Britton, Andrew Christiana, Nicolás L. Ciano-Petersen, Yvette Crijnen, Martin Elišák, Antonio Farina, Alec R. Friedman, Zsófia Hayden, Julien Hébert, Martin Holtkamp, Zhen Hong, Jerome Honnorat, Maria Ilyas-FeldmannSarosh R. Irani, Stjepana Kovac, Petr Marusic, Sergio Muñiz-Castrillo, Sudarshini Ramanathan, Kelsey M. Smith, Claude Steriade, Christine Strippel, Rainer Surges, Maarten J. Titulaer, Christopher E. Uy, Juna M. De Vries, Christian G. Bien, Ulrich Specht

^*Corresponding author for this work

Neurology

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background and Objectives:

Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABABR). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries.

Methods:

This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABABR-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models.

Results:

We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABABR-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85-0.92) for NMDAR, 0.84 (CI 0.80-0.88) for LGI1, 0.82 (CI 0.75-0.90) for CASPR2, and 0.76 (CI 0.62-0.93) for GABABR.

Discussion:

Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.

Original language	English
Article number	e200225
Journal	Neurology: Neuroimmunology and NeuroInflammation
Volume	11
Issue number	4
DOIs	https://doi.org/10.1212/NXI.0000000000200225
Publication status	Published - 4 Jun 2024

Bibliographical note

Publisher Copyright:
© American Academy of Neurology.

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10.1212/NXI.0000000000200225Licence: CC BY-NC-ND

Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABABR AntibodiesFinal published version, 511 KBLicence: CC BY-NC-ND

Cite this

Rada, A., Hagemann, A., Aaberg Poulsen, C., Baumgartner, T., Berki, T., Blaabjerg, M., Brenner, J., Britton, J. W., Christiana, A., Ciano-Petersen, N. L., Crijnen, Y., Elišák, M., Farina, A., Friedman, A. R., Hayden, Z., Hébert, J., Holtkamp, M., Hong, Z., Honnorat, J., ... Specht, U. (2024). Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABA_BR Antibodies: Implications for Return to Driving. Neurology: Neuroimmunology and NeuroInflammation, 11(4), Article e200225. https://doi.org/10.1212/NXI.0000000000200225

@article{e79329039a974a159b27664797603bff,

title = "Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABABR Antibodies: Implications for Return to Driving",

abstract = "Background and Objectives:Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABABR). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries.Methods:This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABABR-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models.Results:We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABABR-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85-0.92) for NMDAR, 0.84 (CI 0.80-0.88) for LGI1, 0.82 (CI 0.75-0.90) for CASPR2, and 0.76 (CI 0.62-0.93) for GABABR.Discussion:Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.",

author = "Anna Rada and Anne Hagemann and {Aaberg Poulsen}, Charlotte and Tobias Baumgartner and Timea Berki and Morten Blaabjerg and Juliette Brenner and Britton, {Jeffrey W.} and Andrew Christiana and Ciano-Petersen, {Nicol{\'a}s L.} and Yvette Crijnen and Martin Eli{\v s}{\'a}k and Antonio Farina and Friedman, {Alec R.} and Zs{\'o}fia Hayden and Julien H{\'e}bert and Martin Holtkamp and Zhen Hong and Jerome Honnorat and Maria Ilyas-Feldmann and Irani, {Sarosh R.} and Stjepana Kovac and Petr Marusic and Sergio Mu{\~n}iz-Castrillo and Sudarshini Ramanathan and Smith, {Kelsey M.} and Claude Steriade and Christine Strippel and Rainer Surges and Titulaer, {Maarten J.} and Uy, {Christopher E.} and {De Vries}, {Juna M.} and Bien, {Christian G.} and Ulrich Specht",

note = "Publisher Copyright: {\textcopyright} American Academy of Neurology.",

year = "2024",

month = jun,

day = "4",

doi = "10.1212/NXI.0000000000200225",

language = "English",

volume = "11",

journal = "Neurology: Neuroimmunology and NeuroInflammation",

issn = "2332-7812",

publisher = "Lippincott Williams & Wilkins",

number = "4",

}

Rada, A, Hagemann, A, Aaberg Poulsen, C, Baumgartner, T, Berki, T, Blaabjerg, M, Brenner, J, Britton, JW, Christiana, A, Ciano-Petersen, NL, Crijnen, Y, Elišák, M, Farina, A, Friedman, AR, Hayden, Z, Hébert, J, Holtkamp, M, Hong, Z, Honnorat, J, Ilyas-Feldmann, M, Irani, SR, Kovac, S, Marusic, P, Muñiz-Castrillo, S, Ramanathan, S, Smith, KM, Steriade, C, Strippel, C, Surges, R, Titulaer, MJ, Uy, CE, De Vries, JM, Bien, CG & Specht, U 2024, 'Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABA_BR Antibodies: Implications for Return to Driving', Neurology: Neuroimmunology and NeuroInflammation, vol. 11, no. 4, e200225. https://doi.org/10.1212/NXI.0000000000200225

Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABA_BR Antibodies: Implications for Return to Driving. / Rada, Anna; Hagemann, Anne; Aaberg Poulsen, Charlotte et al.
In: Neurology: Neuroimmunology and NeuroInflammation, Vol. 11, No. 4, e200225, 04.06.2024.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABABR Antibodies

T2 - Implications for Return to Driving

AU - Rada, Anna

AU - Hagemann, Anne

AU - Aaberg Poulsen, Charlotte

AU - Baumgartner, Tobias

AU - Berki, Timea

AU - Blaabjerg, Morten

AU - Brenner, Juliette

AU - Britton, Jeffrey W.

AU - Christiana, Andrew

AU - Ciano-Petersen, Nicolás L.

AU - Crijnen, Yvette

AU - Elišák, Martin

AU - Farina, Antonio

AU - Friedman, Alec R.

AU - Hayden, Zsófia

AU - Hébert, Julien

AU - Holtkamp, Martin

AU - Hong, Zhen

AU - Honnorat, Jerome

AU - Ilyas-Feldmann, Maria

AU - Irani, Sarosh R.

AU - Kovac, Stjepana

AU - Marusic, Petr

AU - Muñiz-Castrillo, Sergio

AU - Ramanathan, Sudarshini

AU - Smith, Kelsey M.

AU - Steriade, Claude

AU - Strippel, Christine

AU - Surges, Rainer

AU - Titulaer, Maarten J.

AU - Uy, Christopher E.

AU - De Vries, Juna M.

AU - Bien, Christian G.

AU - Specht, Ulrich

PY - 2024/6/4

Y1 - 2024/6/4

N2 - Background and Objectives:Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABABR). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries.Methods:This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABABR-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models.Results:We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABABR-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85-0.92) for NMDAR, 0.84 (CI 0.80-0.88) for LGI1, 0.82 (CI 0.75-0.90) for CASPR2, and 0.76 (CI 0.62-0.93) for GABABR.Discussion:Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.

AB - Background and Objectives:Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABABR). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries.Methods:This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABABR-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models.Results:We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABABR-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85-0.92) for NMDAR, 0.84 (CI 0.80-0.88) for LGI1, 0.82 (CI 0.75-0.90) for CASPR2, and 0.76 (CI 0.62-0.93) for GABABR.Discussion:Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.

UR - http://www.scopus.com/inward/record.url?scp=85198218362&partnerID=8YFLogxK

U2 - 10.1212/NXI.0000000000200225

DO - 10.1212/NXI.0000000000200225

M3 - Article

C2 - 38838283

AN - SCOPUS:85198218362

SN - 2332-7812

VL - 11

JO - Neurology: Neuroimmunology and NeuroInflammation

JF - Neurology: Neuroimmunology and NeuroInflammation

IS - 4

M1 - e200225

ER -

Risk of Seizure Recurrence Due to Autoimmune Encephalitis With NMDAR, LGI1, CASPR2, and GABA_BR Antibodies: Implications for Return to Driving

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