Dubey et al reported the Antibody Prevalence in Epilepsy and Encephalopathy (APE2) Score for evaluating a patient with autoimmune epilepsy. The authors are from the Mayo Clinic and Massachusetts General Hospital.
Patient selection: autoimmune encephalitis
NOTE: This score is similar to the RITE score except that 2 of the latter's items are not used
Parameters:
(1) new onset, rapidly progressive mental status changes that developed in < 6 weeks or new onset seizure activity (within 1 year of evaluation)
(2) neuropsychiatric changes (agitation, aggressiveness, emotional lability)
(3) autonomic dysfunction
(4) viral prodrome (rhinorrhea, sore throat, low-grade fever in the absence of underlying systemic malignancy with 5 years of neurological onset
(5) faciobrachial dystonic seizures
(6) facial dyskinesias
(7) seizures refractory to at least 2 anti-seizure medications
(8) CSF findings consistent with inflammation
(9) brain MRI suggest encephalitis
(10) systemic cancer diagnosed within 5 years of neurological symptom onset (excluding minor skin, brain cancer and metastatic tumors to the brain)
|
Parameter
|
Finding
|
Points
|
|
new onset
|
no
|
0
|
|
|
yes
|
1
|
|
neuropsychiatric changes
|
no
|
0
|
|
|
yes
|
1
|
|
autonomic dysfunction
|
no
|
0
|
|
|
yes
|
1
|
|
viral prodrome
|
no
|
0
|
|
|
yes
|
2
|
|
faciobrachial dystonic seizures
|
no
|
0
|
|
|
yes
|
3
|
|
facial dyskinesia
|
no
|
0
|
|
|
yes
|
2
|
|
refractory seizures
|
no
|
0
|
|
|
yes
|
2
|
|
inflammatory CSF findings
|
no
|
0
|
|
|
yes
|
2
|
|
brain MRI suggests encephalitis
|
no
|
0
|
|
|
yes
|
2
|
|
systemic cancer
|
no
|
0
|
|
|
yes
|
2
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 18 if all 10 items scored
• maximum score with limits on exclusions for items 4 and 7): 14
• An APE2 score >= 4 is 99% sensitive and 93% specific for the presence of neural specific autoantibodies.
