The grey zone between autoimmune encephalitis and autoimmune‐associated epilepsy

Contemporarily, chills began, which the patient described as prolonged episodes (even 30-min long) characterized by a shiver with goosebumps involving his left forearm and rapidly spreading to the ipsilateral arm and back, associated with anxiety and fear “that it might get out of control”. Since these phenomena were attributed to stress, he was prescribed anti-psychotics. [...]this case well exemplifies the complex relationship between immunity and epilepsy and the challenging management of seizures in the context of immune-mediated brain disorders. [...]considering the exceptionally long diagnostic delay, it could be hypothesized that our patient's AE, left untreated, had determined permanent structural damages leading to long-term sequelae, ie mood disorder and temporal lobe epilepsy. 5 This appeared even more likely since Abs directed against intracellular antigens – such as amphiphysin – are associated with T cell–mediated immune processes, which can cause neuronal loss and gliosis and result in post-encephalitic epilepsy more commonly than B cell–mediated ones, according to recent evidence.