Paediatric antibody prevalence in seizure score to predict autoimmune aetiology in seizure disorders

Abstract Aim To modify the antibody prevalence in epilepsy (APE) score of children with suspected autoimmune central nervous system disease with seizures. Methods We retrospectively analysed the cerebrospinal fluid of 157 children (aged 0–18 years) with suspected autoimmune central nervous system disease for antineuronal antibodies in our laboratory from 2016 to 2023. Participants were randomly divided into the development cohort ( n = 79, 35 females; median 7 years, SD 4 years 7 months, range 4–11 years) and validation cohort ( n = 78, 28 females; median 7 years, SD 4 years 5 months, range 4–12 years). A paediatric antibody prevalence in seizure (PAPS) score was created for one cohort and evaluated in the other. Seven variables were selected through univariate and multivariate analysis to create a PAPS score. Results One hundred and fifty‐seven children who fulfilled the inclusion criteria were enrolled; 49 tested positive for antineuronal antibodies. The sensitivity and specificity of an APE score of 4 and greater were 92% and 22.2% respectively; the sensitivity and specificity of a PAPS score of 2.5 and greater were 83.3% and 77.8% respectively. The area under the curve was 0.832 (95% confidence interval = 0.743–0.921), which was significantly better than that for the APE score ( p < 0.001). Interpretation The APE score had high sensitivity but low specificity in children. The PAPS score may be useful for determining the need for antineuronal antibody testing. What this paper adds The antibody prevalence in epilepsy (APE) score had high sensitivity but low specificity in children. The sensitivity and specificity of the paediatric antibody prevalence in seizure (PAPS) score were 83.3% and 77.8% respectively. There were significant differences in the area under the curve for the APE and PAPS scores.