Antibody Prevalence in Epilepsy and Encephalopathy (APE2 ) score
A guide to predict the likelihood of neural antibody positivity in patients with encephalopathy and/or seizures1-2
SCORE
New onset, rapidly progressive mental status changes that developed over 1–6 weeks or new onset seizure activity (within 1 year of evaluation)
+1
Neuropsychiatric changes; agitation, aggressiveness, emotional lability
+1
Autonomic dysfunction
[sustained atrial tachycardia or bradycardia, orthostatic hypotension (≥20 mm Hg fall in systolic pressure or ≥10 mm Hg fall in diastolic pressure within 3 minutes of quiet standing), hyperhidrosis, persistently labile blood pressure, ventricular tachycardia, cardiac asystole, or gastrointestinal dysmotility]
[sustained atrial tachycardia or bradycardia, orthostatic hypotension (≥20 mm Hg fall in systolic pressure or ≥10 mm Hg fall in diastolic pressure within 3 minutes of quiet standing), hyperhidrosis, persistently labile blood pressure, ventricular tachycardia, cardiac asystole, or gastrointestinal dysmotility]
+1
Viral prodrome
(rhinorrhea, sore throat, low-grade fever) to be scored in the absence of underlying systemic malignancy within 5 years of neurological symptom onset
(rhinorrhea, sore throat, low-grade fever) to be scored in the absence of underlying systemic malignancy within 5 years of neurological symptom onset
+2
Faciobrachial dystonic seizures
+3
Facial dyskinesias, to be scored in the absence of faciobrachial dystonic seizures
+2
Seizure refractory from at least two anti-seizure medications
+2
CSF findings consistent with inflammation
(elevated CSF protein >50 mg/dL and/or lymphocytic pleocytosis >5 cells/mcL, if the total number of CSF red blood cell count is <1,000 cells/mcL)
(elevated CSF protein >50 mg/dL and/or lymphocytic pleocytosis >5 cells/mcL, if the total number of CSF red blood cell count is <1,000 cells/mcL)
+2
Brain MRI suggesting encephalitis (T2/FLAIR hypersensitivity restricted to one or both medial temporal
lobes, or multifocal in grey matter, white matter or both compatible with demyelination or inflammation)
+2
Systemic cancer diagnosed within 5 years of neurological symptom onset (excluding cutaneous squamous
cell carcinoma, basal cell carcinoma, brain tumor, cancer with brain metastasis)
+2
CLINICAL REFERENCES
1. Dubey D, Kothapalli N, McKeon A, et al. Predictors of neural-specific autoantibodies and immunotherapy response in patients with cognitive dysfunction. Journal of Neuroimmunology. 2018;323:62-72.
2. Dubey D, Singh J, Britton JW, et al. Predictive models in the diagnosis and treatment of autoimmune epilepsy. Epilepsia. 2017;58(7):1181-1189. doi: 10.1111/epi.13797.