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Our aim was to assess the prevalence of neural autoantibodies in a multicenter national prospective cohort of patients with drug\u2010resistant epilepsy undergoing epilepsy surgery utilizing comprehensive clinical, serologic, and histopathological analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively recruited patients undergoing epilepsy surgery for refractory focal epilepsy not caused by a brain tumor from epilepsy surgery centers in the Czech Republic. Perioperatively, we collected cerebrospinal fluid (CSF) and\/or serum samples and performed comprehensive commercial and in\u2010house assays for neural autoantibodies. Clinical data were obtained from the patients' medical records, and histopathological analysis of resected brain tissue was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010six patients were included, mostly magnetic resonance imaging (MRI)\u2010lesional cases (74%). Mean time from diagnosis to surgery was 21\u2009\u00b1\u200913\u2009years. Only one patient (1.3%) had antibodies in the CSF and serum (antibodies against glutamic acid decarboxylase 65) in relevant titers; histology revealed focal cortical dysplasia (FCD) III (FCD associated with hippocampal sclerosis [HS]). Five patients' samples displayed CSF\u2010restricted oligoclonal bands (OCBs; 6.6%): three cases with FCD (one with FCD II and two with FCD I), one with HS, and one with negative histology. Importantly, eight patients (one of them with CSF\u2010restricted OCBs) had findings on antibody testing in individual serum and\/or CSF tests that could not be confirmed by complementary tests and were thus classified as nonspecific, yet could have been considered specific without confirmatory testing. Of these, two had FCD, two gliosis, and four HS. No inflammatory changes or lymphocyte cuffing was observed histopathologically in any of the 76 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Neural autoantibodies are a rare finding in perioperatively collected serum and CSF of our cohort of mostly MRI\u2010lesional epilepsy surgery patients. Confirmatory testing is essential to avoid overinterpretation of autoantibody\u2010positive findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17894","type":"journal-article","created":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T13:33:41Z","timestamp":1706362421000},"page":"687-697","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low prevalence of neural autoantibodies in perioperative <scp>cerebrospinal fluid<\/scp> samples of epilepsy surgery patients: A multicenter prospective study"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8313-2687","authenticated-orcid":false,"given":"Hana","family":"Moj\u017ei\u0161ov\u00e1","sequence":"first","affiliation":[{"name":"Department of Neurology, Second Faculty of Medicine Charles University and Motol University Hospital  Prague Czech 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