Journal article
Risk of seizure recurrence due to autoimmune encephalitis with NMDAR, LGI1, CASPR2, and GABABR antibodies: implications for return to driving
- Abstract:
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Background and Objectives
Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABABR). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries.
Methods
This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABABR-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models.
Results
We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABABR-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85–0.92) for NMDAR, 0.84 (CI 0.80–0.88) for LGI1, 0.82 (CI 0.75–0.90) for CASPR2, and 0.76 (CI 0.62–0.93) for GABABR.
Discussion
Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 510.9KB, Terms of use)
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- Publisher copy:
- 10.1212/nxi.0000000000200225
Authors
- Publisher:
- Lippincott, Williams & Wilkins
- Journal:
- Neurology, Neuroimmunology and Neuroinflammation More from this journal
- Volume:
- 11
- Issue:
- 4
- Article number:
- e200225
- Place of publication:
- United States
- Publication date:
- 2024-06-04
- Acceptance date:
- 2024-02-06
- DOI:
- EISSN:
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2332-7812
- ISSN:
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2332-7812
- Pmid:
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38838283
- Language:
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English
- Pubs id:
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2008523
- Local pid:
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pubs:2008523
- Deposit date:
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2025-02-05
- ARK identifier:
Terms of use
- Copyright holder:
- Rada et al.
- Copyright date:
- 2024
- Rights statement:
- © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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