Refractory epilepsy associated with anti-ribosomal P antibodies successfully treated with topiramate

• Published in: Journal of neuroimmunology Vol. 340; p. 577144
• Main Authors: Uribe-San-Martín, R., Ciampi, E., Cruz, J.P., Vásquez, M., Cárcamo, C.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.03.2020
• Subjects: Anti-ribosomal P antibodies; Autoimmune epilepsy; Neuroimmunology; Refractory epilepsy; Systemic lupus erythematosus; Refractory epilepsy; Anti-ribosomal P antibodies; Systemic lupus erythematosus; Neuroimmunology; Autoimmune epilepsy
• ISSN: 0165-5728; 1872-8421
• DOI: 10.1016/j.jneuroim.2020.577144

We report the case of a 25-year-old woman who developed temporal lobe epilepsy associated with systemic lupus erythematosus (SLE). Serum and cerebrospinal fluid samples showed high titers of anti-ribosomal P (anti-P) antibodies with negative anti-NMDAR antibodies. She was receiving prednisone and azathioprine, with normalization of SLE serum markers, but without changes in titers of anti-P antibodies. No seizure control was achieved using valproic acid, levetiracetam and lamotrigine. However, she had a selective response to topiramate, an AMPAR blocker, maintained during 6 years of follow-up. We discuss the pathophysiology of this autoimmune epilepsy associated with high titer anti-P antibodies. [Display omitted] •Anti-P antibodies have been associated with neuropsychiatric symptoms in SLE.•There could be a pathogenic link between these antibodies and epilepsy.•These antibodies increase glutamatergic activity at the synapse in animal models.•A selective blockade with topiramate may be considered in epilepsy with anti-P.