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.