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
N1 - Publisher Copyright:
© American Academy of Neurology.
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 - https://www.scopus.com/pages/publications/85198218362
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 -