Immune context and treatment timing associated with seizure freedom after rituximab in autoimmune limbic encephalitis
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Summary Seizure freedom represents a clinically meaningful outcome in autoimmune limbic encephalitis (ALE). Rituximab (RTX) is commonly used, but the factors associated with seizure outcomes remain unclear. We conducted a retrospective single-center cohort study including 107 adults with ALE and seizures treated between 2005 and 2024. Patients were stratified by RTX treatment, treatment timing, cerebrospinal fluid (CSF) findings, and seizure outcome. The primary endpoint was seizure freedom for ≥12 months. Overall, 72/107 patients (70.6%) achieved seizure freedom, including 18 RTX-treated patients. Earlier RTX initiation (< 12 months) was numerically associated with higher seizure freedom rates than later treatment (77.8% vs. 37.5%). In RTX-treated patients, positive CSF immune findings were associated with seizure freedom (100% vs. 62.5%). Combining early RTX initiation and positive CSF findings was associated with increased odds of seizure freedom. In multivariable analysis, RTX treatment was not independently associated with seizure freedom. These exploratory findings require prospective validation. abs0010 Graphical abstract http://www.w3.org/1999/xlink float portrait ga1.jpg undfig1 anchor portrait graphical abs0015 Highlights • Early rituximab initiation is associated with higher seizure freedom in ALE u0010 • CSF immune features are associated with seizure outcomes following rituximab u0015 • Treatment timing and immune context may improve stratification of seizure out
Abstract
Summary Seizure freedom represents a clinically meaningful outcome in autoimmune limbic encephalitis (ALE). Rituximab (RTX) is commonly used, but the factors associated with seizure outcomes remain unclear. We conducted a retrospective single-center cohort study including 107 adults with ALE and seizures treated between 2005 and 2024. Patients were stratified by RTX treatment, treatment timing, cerebrospinal fluid (CSF) findings, and seizure outcome. The primary endpoint was seizure freedom for ≥12 months. Overall, 72/107 patients (70.6%) achieved seizure freedom, including 18 RTX-treated patients. Earlier RTX initiation (< 12 months) was numerically associated with higher seizure freedom rates than later treatment (77.8% vs. 37.5%). In RTX-treated patients, positive CSF immune findings were associated with seizure freedom (100% vs. 62.5%). Combining early RTX initiation and positive CSF findings was associated with increased odds of seizure freedom. In multivariable analysis, RTX treatment was not independently associated with seizure freedom. These exploratory findings require prospective validation. abs0010 Graphical abstract http://www.w3.org/1999/xlink float portrait ga1.jpg undfig1 anchor portrait graphical abs0015 Highlights • Early rituximab initiation is associated with higher seizure freedom in ALE u0010 • CSF immune features are associated with seizure outcomes following rituximab u0015 • Treatment timing and immune context may improve stratification of seizure outcomes u0020 • Seizure freedom represents a clinically meaningful outcome in ALE u0025 simple ulist0010 author-highlights abs0020 Clinical finding; Treatment; Immune system disorder teaser abs0025