Immune mechanism in Benign Epilepsy with Centrotempral Spikes

Introduction: Benign Epilepsy with Centrotempral Spikes(BECT) is the most common focal epilepsy among pediatric epilepsies. We found part of BECT patients always coexist with herpesviridae latent infection including Epstein-Barr Virus (EBV) and Human cytomegalovirus (HCMV). EBV and CMV infection could trigger or exacerbate the autoimmune disease. It reminds us of possible autoimmune pathology of BECTs. Method: We recruited autoimmune associated BECTs Cases in 2019.12 to 2021.12 admitted to our department, collected demographic data and clinical information such as frequency of seizures, the baseline EEG and spike-wave index(SWI), the annti-Epileptic Drugs (AED), imaging of the Central neural system, CSF testing. Antibody Prevalence in Epilepsy and Encephalopathy score (APE2) was evaluated in each one. Then observe efficiency of the immune therapy . Result: We enrolled 9 patients diagnosed autoimmune associated BECT. 3 Patients was found anti-Recoverin antibody, anti-NMDAR antibody, and anti-ANNA2 antibody in serum or/and CSF. 88.9%patients was proved to autoimmune epilesy according to RITE score≥4. 88.9% patients had latent virus infection. 88.9% patients got seizure free at 3 months after immune treatment. EEG of 44.4% patients turned into normal. Difference of SWI in before and after treatment showed decrease 46%±32% (P=0.0049). There were no sever side effect of immune therapy observed in all the patients. Conclusion: Latent virus infection may triggered immune associated epilepsy which could presented as BECT with neural antibody positive or negative. Autoimmune associated BECT showed tendency into atypical development. Immune therapy could control seizures and decrease rolandic spikes without severe side effect in autoimmune associated BECT patients.
Keywords: Benign Epilepsy with Centrotempral Spikes(BECT), autoimmune epilepsy, virus latent infection.