Dubey et al reported the Responsiveness to Immunotherapy in Epilepsy (RITE) Score for evaluating a patient with autoimmune epilepsy. The authors are from the Mayo Clinic and Massachusetts General Hospital.
Patient selection: autoimmune encephalitis
Parameters:
(1) new onset, rapidly progressive mental status changes that developed in < 6 weeks or new onset seizure activity
(2) neuropsychiatric changes (agitation, aggressiveness, emotional lability)
(3) autonomic dysfunction
(4) viral prodrome (rhinorrhea, sore throat, low-grade fever
(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)
(11) immunotherapy initiated within 6 months of symptom onset
(12) neural membrane autoantibodies in serum or plasma
|
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
|
|
immunotherapy
|
no
|
0
|
|
|
yes
|
2
|
|
neural membrane autoantibodies present in serum/plasma
|
no
|
0
|
|
|
yes
|
2
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 22 if all 12 items scored
• maximum score with limits on exclusions for items 4 and 7): 18
• A RITE score >= 7 is 96% sensitive and 86% specific for a favorable response to initial immunotherapy.
