Immune-mediated seizures are rare but are increasingly recognized as an etiology of seizures resistant to anti-seizure medications (ASMs). Antibody Prevalence in Epilepsy 2 (APE2) and Response to Immunotherapy in Epilepsy 2 (RITE2) scores were developed recently to identify patients who may be seropositive for serum central nervous system (CNS) specific antibodies (Ab) and may benefit from immunotherapy (Dubey et al. 2018). The goal of this study was to apply APE2 and RITE2 scores to an independent cohort of patients with seizures secondary to autoimmune encephalitis (AE) and to further verify the sensitivity and specificity of the scores. We conducted a retrospective study at Stanford University Hospital between 2008 and 2021 and included patients who had acute seizures and AE using diagnostic criteria from Graus (n = 34 definite AE, 10 probable AE, and 12 possible AE) (Graus et al. 2016). Patients were excluded if they did not have a serum Ab panel investigated or had alternate diagnoses (n = 55). APE2 and RITE2 scores were calculated based on clinical and diagnostic data (n = 56). Serum Ab were positive in 73 % of patients, in which 63 % cases carried CNS specific Ab. An APE2 score ≥ 4 had a sensitivity of 97 % and specificity of 14 % to predict a positive serum CNS specific Ab. A RITE2 score ≥ 7 had a sensitivity of 93 % and specificity of 60 % to predict seizure responsiveness to immunotherapy. APE2 and RITE2 scores had high sensitivities but low specificities to predict seropositivity and seizure responsiveness to immunotherapy in patients with autoimmune encephalitis with seizures.

中文翻译：

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APE2 和 RITE2 评分在自身免疫性脑炎癫痫患者中的应用

免疫介导的癫痫发作很少见，但越来越多地被认为是抗癫痫药物 (ASM) 耐药的癫痫发作的病因。最近开发了癫痫 2 型抗体流行率 (APE2) 和癫痫 2 号免疫治疗反应 (RITE2) 评分，以识别血清中枢神经系统 (CNS) 特异性抗体 (Ab) 可能呈血清阳性且可能受益于免疫治疗的患者（Dubey 等）等2018）。本研究的目的是将 APE2 和 RITE2 评分应用于继发于自身免疫性脑炎 (AE) 的癫痫发作患者的独立队列，并进一步验证评分的敏感性和特异性。我们于 2008 年至 2021 年间在斯坦福大学医院进行了一项回顾性研究，纳入了使用 Graus 诊断标准的急性癫痫发作和 AE 患者（n = 34 例明确 AE、10 例可能 AE 和 12 例可能 AE）（Graus 等人，2016 年） 。如果患者没有进行血清抗体组调查或有其他诊断，则被排除在外 (n = 55)。 APE2 和 RITE2 评分是根据临床和诊断数据计算的 (n = 56)。 73%的患者血清抗体呈阳性，其中63%的病例携带中枢神经系统特异性抗体。 APE2 评分≥ 4 时，预测血清 CNS 特异性抗体阳性的敏感性为 97%，特异性为 14%。 RITE2 评分 ≥ 7 预测癫痫对免疫治疗的反应的敏感性为 93%，特异性为 60%。 APE2 和 RITE2 评分对于预测伴有癫痫发作的自身免疫性脑炎患者的血清阳性和免疫治疗癫痫反应反应具有较高的敏感性，但特异性较低。