{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:46:37Z","timestamp":1788259597085,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T00:00:00Z","timestamp":1634774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008997","name":"Sociedad Andaluza de Neurolog\u00eda","doi-asserted-by":"publisher","award":["SAN Fellowship to N C-P"],"award-info":[{"award-number":["SAN Fellowship to N C-P"]}],"id":[{"id":"10.13039\/501100008997","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Consejer\u00eda de Salud y Familias","award":["Neuro-RECA -Andalusian Clinical and Translational Research Network-, RIC-0111.2019 to PJ. S-C"],"award-info":[{"award-number":["Neuro-RECA -Andalusian Clinical and Translational Research Network-, RIC-0111.2019 to PJ. S-C"]}]},{"name":"Consejer\u00eda de Salud y Familias","award":["Nicolas Monardes Programme to G E-T"],"award-info":[{"award-number":["Nicolas Monardes Programme to G E-T"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In order to determine the prevalence of neural autoantibodies in adult patients with drug-resistant temporal lobe epilepsy (DRTLE) of unknown etiology, we compared the characteristics of patients with and without autoantibodies and applied antibody predictive scores to the patients. Patients aged \u226518 years with DRTLE of unknown etiology and \u226512 months of evolution were prospectively recruited. Neural autoantibodies in serum and CSF were systematically determined in all patients. We created the ARTE (antibody in drug-resistant temporal lobe epilepsy) score based on the variables associated with the presence of neural autoantibodies. Twenty-seven patients were included. The mean (SD) age in years at the index date was 52 (\u00b114.2) and at epilepsy onset was 32 (\u00b117.1). The mean epilepsy duration was 19 (\u00b112.5) years. Neural autoantibodies were detected in 51.85% (14\/27) of patients. The presence of bitemporal, independent, interictal epileptiform discharges (BIIED) had a higher frequency in patients with neural autoantibodies (57.1% vs. 15.4%; p = 0.025) as well as those patients with a previous history of status epilepticus (49.2% vs. 0.0%; p = 0.007). The ARTE score showed an area under the curve (AUC) of 0.854. Using a cut-off point of \u22651, the sensitivity was 100% and the specificity was 46.1%, whereas when using a cut-off point of \u22653, the results were 35.7% and 100%, respectively. We found a high prevalence of neural autoantibodies in patients with DRTLE of unknown etiology, indicating an autoimmune mechanism. The presence of BIIED and a history of SE in DRTLE of unknown etiology are possible markers for autoimmune-associated epilepsy. The proposed ARTE score requires future validation in larger independent cohorts.<\/jats:p>","DOI":"10.3390\/jcm10214843","type":"journal-article","created":{"date-parts":[[2021,10,22]],"date-time":"2021-10-22T00:22:02Z","timestamp":1634862122000},"page":"4843","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Prevalence of Neural Autoantibodies in Paired Serum and Cerebrospinal Fluid in Adult Patients with Drug-Resistant Temporal Lobe Epilepsy of Unknown Etiology"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6421-5348","authenticated-orcid":false,"given":"Pablo","family":"Cabezudo-Garc\u00eda","sequence":"first","affiliation":[{"name":"Biomedical Research Institute of M\u00e1laga-IBIMA, 29010 M\u00e1laga, Spain"},{"name":"Neurosciences Clinical Unit, University Regional Hospital of M\u00e1laga, 29010 M\u00e1laga, Spain"},{"name":"School of Medicine, University of M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9555-4847","authenticated-orcid":false,"given":"Nicol\u00e1s L.","family":"Ciano-Petersen","sequence":"additional","affiliation":[{"name":"Biomedical Research Institute of M\u00e1laga-IBIMA, 29010 M\u00e1laga, Spain"},{"name":"Neurosciences Clinical Unit, University Regional Hospital of M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6173-2051","authenticated-orcid":false,"given":"Natalia","family":"Mena-V\u00e1zquez","sequence":"additional","affiliation":[{"name":"Biomedical Research Institute of M\u00e1laga-IBIMA, 29010 M\u00e1laga, Spain"},{"name":"Rheumatology Clinical Unit, University Regional Hospital of M\u00e1laga, 29009 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Ortega-Pinazo","sequence":"additional","affiliation":[{"name":"Biomedical Research Institute of M\u00e1laga-IBIMA, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda J.","family":"Postigo-Pozo","sequence":"additional","affiliation":[{"name":"Biomedical Research Institute of M\u00e1laga-IBIMA, 29010 M\u00e1laga, Spain"},{"name":"Neurosciences Clinical Unit, University Regional Hospital of M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3894-9716","authenticated-orcid":false,"given":"Guillermina","family":"Garc\u00eda-Mart\u00edn","sequence":"additional","affiliation":[{"name":"Biomedical Research Institute of M\u00e1laga-IBIMA, 29010 M\u00e1laga, Spain"},{"name":"Neurosciences Clinical Unit, University Regional Hospital of M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Antol\u00ed-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Biomedical Research Institute of M\u00e1laga-IBIMA, 29010 M\u00e1laga, Spain"},{"name":"Neurosciences Clinical Unit, University Regional Hospital of M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Violeta","family":"S\u00e1nchez-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Neurology and Neurophysiology Unit, University Hospital Virgen Macarena, 41009 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4272-4475","authenticated-orcid":false,"given":"Pablo","family":"Quiroga-Subirana","sequence":"additional","affiliation":[{"name":"Neurology Unit, Hospitalary Complex Torrec\u00e1rdenas, 04009 Almer\u00eda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3414-2707","authenticated-orcid":false,"given":"Pedro J.","family":"Serrano-Castro","sequence":"additional","affiliation":[{"name":"Biomedical Research Institute of M\u00e1laga-IBIMA, 29010 M\u00e1laga, Spain"},{"name":"Neurosciences Clinical Unit, University Regional Hospital of M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7124-2678","authenticated-orcid":false,"given":"Guillermo","family":"Estivill-Torr\u00fas","sequence":"additional","affiliation":[{"name":"Biomedical Research Institute of M\u00e1laga-IBIMA, 29010 M\u00e1laga, Spain"},{"name":"Neurosciences Clinical Unit, University Regional Hospital of M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1111\/epi.13709","article-title":"ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology","volume":"58","author":"Scheffer","year":"2017","journal-title":"Epilepsia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1172\/JCI125178","article-title":"Autoimmune seizures and epilepsy","volume":"129","author":"Geis","year":"2019","journal-title":"J. Clin. Investig."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1111\/epi.16571","article-title":"Acute symptomatic seizures secondary to autoimmune encephalitis and autoimmune-associated epilepsy: Conceptual definitions","volume":"61","author":"Steriade","year":"2020","journal-title":"Epilepsia"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kuehn, J.C., Meschede, C., Helmstaedter, C., Surges, R., von Wrede, R., Hattingen, E., Vatter, H., Elger, C.E., Schoch, S., and Becker, A.J. (2020). Adult-onset temporal lobe epilepsy suspicious for autoimmune pathogenesis: Autoantibody prevalence and clinical correlates. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0241289"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.seizure.2020.09.032","article-title":"Development and validation of a predictive model for the diagnosis of neural antibody-mediated epilepsy\/ seizure in patients with new-onset seizure or established epilepsy","volume":"83","author":"Zhang","year":"2020","journal-title":"Seizure"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cabezudo-Garc\u00eda, P., Mena-V\u00e1zquez, N., Ciano-Petersen, N.L., Garc\u00eda-Mart\u00edn, G., Estivill-Torr\u00fas, G., and Serrano-Castro, P.J. (2021). Prevalence of neural autoantibodies in epilepsy of unknown etiology: Systematic review and meta-analysis. Brain Sci., 11.","DOI":"10.3390\/brainsci11030392"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S1474-4422(15)00401-9","article-title":"A clinical approach to diagnosis of autoimmune encephalitis","volume":"15","author":"Graus","year":"2016","journal-title":"Lancet Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1111\/epi.14649","article-title":"Antibody Prevalence in Epilepsy and Encephalopathy score: Increased specificity and applicability","volume":"60","author":"Dubey","year":"2019","journal-title":"Epilepsia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1111\/epi.16820","article-title":"Antibody Prevalence in Epilepsy before Surgery (APES) in drug-resistant focal epilepsy","volume":"62","author":"Li","year":"2021","journal-title":"Epilepsia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1002\/ana.26013","article-title":"Antibodies Contributing to Focal Epilepsy Signs and Symptoms Score","volume":"89","author":"Bastiaansen","year":"2021","journal-title":"Ann. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1001\/jamaneurol.2016.5429","article-title":"Neurological autoantibody prevalence in epilepsy of unknown etiology","volume":"74","author":"Dubey","year":"2017","journal-title":"JAMA Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1212\/WNL.0000000000011839","article-title":"Incidence and Prevalence of Drug-Resistant Epilepsy: A Systematic Review and Meta-analysis","volume":"96","author":"Sultana","year":"2021","journal-title":"Neurology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/epi.12550","article-title":"ILAE Official Report: A practical clinical definition of epilepsy","volume":"55","author":"Fisher","year":"2014","journal-title":"Epilepsia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1111\/epi.15612","article-title":"Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: A consensus report from the International League Against Epilepsy Neuroimaging Task Force","volume":"60","author":"Bernasconi","year":"2019","journal-title":"Epilepsia"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1111\/j.1528-1167.2009.02397.x","article-title":"Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies","volume":"51","author":"Kwan","year":"2010","journal-title":"Epilepsia"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.yebeh.2007.03.011","article-title":"Limbic encephalitis: A cause of temporal lobe epilepsy with onset in adult life","volume":"10","author":"Bien","year":"2007","journal-title":"Epilepsy Behav."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1007\/s13311-019-00750-3","article-title":"Autoimmune Epilepsy","volume":"16","author":"Husari","year":"2019","journal-title":"Neurotherapeutics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1038\/s41582-020-0359-x","article-title":"GAD antibodies in neurological disorders\u2014Insights and challenges","volume":"16","author":"Graus","year":"2020","journal-title":"Nat. Rev. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1111\/epi.13121","article-title":"A definition and classification of status epilepticus\u2014Report of the ILAE Task Force on Classification of Status Epilepticus","volume":"56","author":"Trinka","year":"2015","journal-title":"Epilepsia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.seizure.2018.05.004","article-title":"Efficacy of antiepileptic drugs in autoimmune epilepsy: A systematic review","volume":"59","year":"2018","journal-title":"Seizure"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.3174\/ajnr.A5086","article-title":"Autoimmune encephalitis: Pathophysiology and imaging review of an overlooked diagnosis","volume":"38","author":"Kelley","year":"2017","journal-title":"Am. J. Neuroradiol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Steriade, C., Gillinder, L., Rickett, K., Hartel, G., Higdon, L., Britton, J., and French, J. (2021). Discerning the Role of Autoimmunity and Autoantibodies in Epilepsy: A Review. JAMA Neurol.","DOI":"10.1001\/jamaneurol.2021.3113"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jns.2018.10.026","article-title":"Factors underlying the development of chronic temporal lobe epilepsy in autoimmune encephalitis","volume":"396","author":"Casciato","year":"2019","journal-title":"J. Neurol. Sci."},{"key":"ref_24","first-page":"E2185","article-title":"Evaluation of seizure treatment in anti-LGI1, anti-NMDAR, and anti-GABABR encephalitis","volume":"92","author":"Bastiaansen","year":"2019","journal-title":"Neurology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1212\/WNL.0000000000001940","article-title":"New-onset refractory status epilepticus: Etiology, clinical features, and outcome","volume":"85","author":"Gaspard","year":"2015","journal-title":"Neurology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/epi.14515","article-title":"Long-term outcomes of status epilepticus: A critical assessment","volume":"59","author":"Sculier","year":"2018","journal-title":"Epilepsia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/S1474-4422(18)30244-8","article-title":"Spanish Herpes Simplex Encephalitis Study Group. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: A prospective observational study and retrospective analysis","volume":"17","author":"Armangue","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"686","DOI":"10.3389\/fimmu.2019.00686","article-title":"Autoimmunity After Ischemic Stroke and Brain Injury","volume":"10","author":"Javidi","year":"2019","journal-title":"Front. Immunol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/4843\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:20:36Z","timestamp":1760167236000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/4843"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,21]]},"references-count":28,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jcm10214843"],"URL":"https:\/\/doi.org\/10.3390\/jcm10214843","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,21]]}}}