Autoantibodies in the Patient With Drug-Resistant Epilepsy:  Are We Missing a Treatable Etiology?

Partial seizures are the most common seizure type, affecting more than 50% of patients with seizure disorders. Unfortunately, only about half of these patients with partial seizures can have their seizures controlled with antiepileptic medications; primary generalized seizures are much more readily controlled. This relative refractoriness is thought to be due to symptomatic or cryptogenic causes for the seizures. Evaluations of these patients often focus on using sophisticated imaging techniques to attempt to find structural causes and to enhance surgical candidacy. When routine magnetic resonance imaging and positron emission tomography fail to demonstrate an epileptogenic lesion, it is assumed that our imaging techniques are not sensitive enough and that we need to improve on available technology with higher-strength magnetic fields or sophisticated methods for cortical reconstruction, as we search for the small area of hippocampal abnormality or cortical dysplasia that might be the cause of the seizures.