Background: Acute symptomatic seizures (ASS) are a common manifestation of autoimmune encephalitis (AE), but the risk of developing epilepsy as a sequela of AE remains unknown, and factors predisposing the development of epilepsy have not been fully identified. Objective: To assess the risk of developing epilepsy in AE and study related risk factors. Materials and methods: This was a retrospective single centre study including patients diagnosed with AE according to criteria described by Graus et al., with a minimum follow-up of 12 months after AE resolution. The sample was divided according to whether patients developed epilepsy or not. Results: A total of 19 patients were included; 3 (15.8%) had AE with intracellular antibodies, 9 (47.4%) with extracellular antibodies, and 7 (36.8%) were seronegative. During follow-up, 3 patients (15.8%) died, 4 (21.1%) presented relapses of AE, and 11 (57.89%) developed epilepsy. There was a significant association between the development of epilepsy and the presence of hippocampal atrophy in control brain magnetic resonance imaging (MRI) (p = 0.037), interictal epileptiform discharges (IED) on control electroencephalogram (EEG) (p = 0.045), and immunotherapy delay (p = 0.016). Conclusions: Hippocampal atrophy in neuroimaging, IED on EEG during follow-up, and immunotherapy delay could be predictors of the development of epilepsy in patients with AE.

The 2024 revision of the McDonald criteria introduces specific recommendations for diagnosing late-onset multiple sclerosis (LOMS). One of the following criteria must be met: spinal cord lesions, positive cerebrospinal fluid (CSF) findings, or fulfilment of the Select-6 criteria (i.e., six or more central vein signs on brain magnetic resonance imaging (MRI)). To evaluate the sensitivity of the 2024 McDonald criteria in patients with LOMS and to identify the most sensitive diagnostic test. This cross-sectional, observational, retrospective study included patients diagnosed with LOMS (onset ≥50 years of age) who were followed at the Multiple Sclerosis Clinic of Bellvitge University Hospital. Clinical records, MRI scans, and CSF analyses were reviewed to assess the presence of spinal cord lesions, central vein signs and oligoclonal bands (OCBs). The sensitivity of the 2024 recommended LOMS criteria was analysed. 115 patients met at least one of the proposed 2024 LOMS diagnostic criteria, resulting in a sensitivity of 100 %. Of these, 10.4 % fulfilled all three criteria, 52.1 % met two criteria (most commonly OCBs and spinal lesions). The remaining 37.4 % met only one: 53.5 % had spinal lesions, 46.5 % were positive for OCBs, and none met only the Select-6 criterion. The difference between the proportions meeting the OCB and spinal cord lesion criteria was not statistically significant (p = 0.581), but both were significantly more common than meeting the Select-6 criterion (p < 0.001). The 2024 McDonald criteria maintain high sensitivity for diagnosing LOMS. CSF analysis and spinal MRI are the most valuable tools, whereas the Select-6 criteria exhibited a lower diagnostic value.

BACKGROUND: Infliximab (IFX) trough concentrations (C_min) have been linked to treatment efficacy in psoriatic patients. Inter-individual IFX C_min variability and factors influencing IFX pharmacokinetics could explain differences in treatment response. OBJECTIVE: To evaluate the association between IFX C_min and clinical outcomes in psoriatic patients. METHODS: Prospective study of 33 patients with moderate to severe psoriasis receiving IFX at Bellvitge University Hospital, between October 2013-November 2016. IFX C_min and antibodies toward infliximab (ATI) were measured. RESULTS: We collected 155 IFX C_min and ATI values (mean age, 46 (14) years; 11 (33.3%) women). Mean IFX C_min was 2.5 (2.4) mg/L and ATIs were detected in six patients, resulting in undetectable IFX C_min. IFX C_min were significantly associated with ATI and BMI (β -2.51, 95% CI -3.56 to -1.4 and β -0.05, 95% CI -0.09 to -0.01). PASI score and PASI 90/100 response were significantly associated with IFX C_min (IRR 0.80, 95% CI 0.70 to 0.92; OR 1.79, 95% CI 1.18 to 2.71 and OR 1.79, 95% CI 1.14 to 2.81). CONCLUSION: IFX C_min significantly influences PASI 90/100 response rates. IFX C_min were significantly associated with ATI and BMI. The observed inter-individual variability in IFX C_min supports the need for IFX drug monitoring.

The association between epilepsy and myasthenia gravis has rarely been reported, and when it has been reported, it has only been in a small case series. The aim of the present study was to report the frequency of epilepsy and myasthenia gravis and to describe a case series of patients with myasthenia gravis and epilepsy, focusing on their clinical characteristics and searching for a possible physiopathological mechanism. A retrospective, observational, adult center study was conducted in 2022. Patients were recruited from the database of the outpatient clinic of the Myasthenia Gravis and Epilepsy Unit of the Neurology Service, Hospital Universitari de Bellvitge. Five patients were included. The frequency of epilepsy in the myasthenia gravis cohort was 5/469 (1.1%), and the frequency of myasthenia gravis in the epilepsy cohort was 5/1432 (0.35%). All patients suffered from focal epilepsy, mainly temporo-central, which was drug-resistant in 3/5 Myasthenia gravis, which was generalized and with exacerbations in 3/5. Three patients were thymectomized (anatomopathology: thymic hyperplasia). Other autoimmune diseases were found in two (40%). Epilepsy onset preceded myasthenia gravis onset in all patients. Both diseases were considered autoimmune-related in 3/5, related to genetic predisposition due to altered innate immune system in 1/5, and due to chance or to treatment in 1/5. Epilepsy and myasthenia gravis are only infrequently associated. In adult patients, epilepsy onset precedes myasthenia onset in most cases. In some cases, epilepsy has an autoimmune etiology and coexists with other autoimmune conditions.

Introduction: The association between epilepsy and myasthenia gravis has rarely been reported, and only in small case series. Objective: To report the frequency of epilepsy and myasthenia gravis and to describe a case series of patients with myasthenia gravis and epilepsy, focusing on their clinical characteristics and searching for a possible physiopathological mechanism. Methods: A retrospective, observational, adult center study was conducted in 2022. Patients were recruited from the database of the outpatient clinic of the Myasthenia Gravis unit and Epilepsy unit. Results: Five patients were included. Frequency of epilepsy in the myasthenia gravis cohort was 5/469 (1.1%), and of myasthenia gravis in the epilepsy cohort was 5/1432 (0.35%). All patients suffered focal epilepsy, mainly fronto-central, and drug-resistant in half of them. Myasthenia gravis was generalized and with exacerbations in half of them. Three patients were thymectomized. Other autoimmune diseases were found in 2 (40%). Epilepsy onset preceded myasthenia gravis onset in all patients. Both diseases were considered autoimmune-related in 3/5 (60%). Conclusion: Epilepsy and myasthenia gravis are only infrequently associated. In adult patients, epilepsy onset precedes myasthenia onset in most cases. In some cases, epilepsy has an autoimmune aetiology and coexists with other autoimmune conditions.