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The Potential of Immunoglobulin Therapy in Intractable Seizures

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Summary

Immunological mechanisms have been implicated in the pathogenesis of epileptic seizures in experimental animal models of epilepsy and in some patients with epilepsy. In the wake of these observations, clinical trials with high dose intravenous gamma immunoglobulin (IVIg) have shown this drug to be effective and well tolerated in some children with intractable seizures. The overall results with IVIg are encouraging — complete remission occurs in 25% of patients and mild to moderate response is observed in 30%. Particularly favourable results are obtained in patients with a short duration of seizure disorder and relatively preserved cognitive function prior to therapy.

The full potential of IVIg in intractable epilepsy will only be defined following a better understanding of the intricacies of the mechanisms involved in epileptic syndromes and IVIg therapy. Long term controlled studies designed to identify predictors of response, optimal timing, dose and duration of IVIg therapy are needed.

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References

  1. Hauser WA, Hesdorffer DC. Epilepsy, frequency, causes and consequences. New York: Demos Publication, 1990

    Google Scholar 

  2. Delezenne C. Serumes nervotoxiques. Annales d’Institut Pasteur 1900; 14: 686–704

    Google Scholar 

  3. Karpiak SE, Graf L, Rapport MM. Antiserum to brain gangliosides produces recurrent epileptiform activity. Science 1976; 194: 735–7

    Article  PubMed  CAS  Google Scholar 

  4. Mihailovic LJT, Cupic D. Epileptiform activity evoked by intracerebral injection of anti-brain antibodies. Brain Res 1971; 32: 74–124

    Article  Google Scholar 

  5. Plioplys AV, Greaves A, Yoshida W. Anti-CNS antibodies in childhood neurological diseases. Neuropediatrics 1989; 20: 93–102

    Article  PubMed  CAS  Google Scholar 

  6. Lischka A, Herkner K, Pollak A. Neuroimmunologische parameter bei therapieresistenter epilepsie im kindesalter. Wien Klin Wochenschr 1990; 102: 227–30

    PubMed  CAS  Google Scholar 

  7. Eeg-Olofsson O, Prchal JF, Andermann F. Abnormalities of T-lymphocyte subsets in epileptic patients. Acta Neurol Scand 1985; 72: 140–4

    Article  PubMed  CAS  Google Scholar 

  8. Aarli JA, Fontana A. Immunological aspects of epilepsy. Epilepsia 1980; 21: 451–7

    Article  PubMed  CAS  Google Scholar 

  9. Fontana A, Sauter R, Grob PJ, et al. IgA deficiency, epilepsy and hydantoin medication. Lancet 1976; 2: 228–31

    Article  PubMed  CAS  Google Scholar 

  10. Duse M, Tiberti S, Plebani A, et al. IgG2 deficiency and intractable epilepsy of childhood. Monogr Allergy 1986; 20: 128–34

    PubMed  CAS  Google Scholar 

  11. Spina A, Losito R, Marzocco P, et al. Treatment of intractable childhood epilepsy with high doses of intravenous gammaglobulins. Acta Neurol (Napoli) 1989; 11: 415–22

    CAS  Google Scholar 

  12. Sterio M, Gebauer E, Vucicevic G, et al. Intravenous immunoglobulin bei der behandlung uon malignen epilepsien bei kindern. Wien Klin Wochenschr 1990; 102: 230–3

    PubMed  CAS  Google Scholar 

  13. Illum N, Taudorf K, Heilmann C, et al. Intravenous immunoglobulin: a single blind trial in children with Lennox-Gastaut syndrome. Neuropediatrics 1990; 21: 87–90

    Article  PubMed  CAS  Google Scholar 

  14. Benson M, Blennow G, Rasen I. Intrathecal immunoglobulin production and minor motor seizures. Acta Paediatr Scand 1987; 76: 147–50

    Article  PubMed  CAS  Google Scholar 

  15. Meencke HJ, Janz D. Neuropathological findings in primary generalized epilepsy: a study of eight cases. Epilepsia 1984; 25: 8–14

    Article  PubMed  CAS  Google Scholar 

  16. Schwartz SA, Gordon KE, Johnston MV, et al. Use of intravenous immune globulin in the treatment of seizure disorders. J Allergy Clin Immunol 1989; 84: 603–7

    Article  PubMed  CAS  Google Scholar 

  17. Pechadre JC, Sauvezie B, Osier C, et al. Traitement des encephalopathies epileptiques de l’enfant par les gammaglobulines. Rev EEG Neurophysiol 1977; 7: 443–7

    CAS  Google Scholar 

  18. Laffont F, Cathala HP, Pechadre JC, et al. Effects a court terme des gamma-globulines sur l’organisation du sommeil chez des malades epileptiques. Rev EEG Neurophysiol 1979; 9: 266–76

    CAS  Google Scholar 

  19. Fois A, Vascutto M. Use of intravenous immunoglobulins in drug-resistant epilepsy. Childs Nerv Syst 1990; 6: 400–5

    Article  PubMed  CAS  Google Scholar 

  20. Gross-Tsur V, Shalev RS, Kazir E, et al. Intravenous high dose gammaglobulin for intractable childhood epilepsy. Acta Neurol Scand 1993; 88: 204–9

    Article  PubMed  CAS  Google Scholar 

  21. Hibio S, Michihiro N, Ogawa K, et al. Clinical effects and serum globulin changes following non-treated immunoglobulin treatment in West syndrome. Brain Dev 1985; 7: 183

    Google Scholar 

  22. Voit T. High dose immunoglobulin treatment of epilepsy in children. Infusionsther Transfusionsmed 1993; 20(1 Suppl.): 146–9

    PubMed  Google Scholar 

  23. Ariizumi M, Shiihara H, Hibio S, et al. High dose gammaglobulin for intractable childhood epilepsy. Lancet 1983; 8342: 162–3

    Article  Google Scholar 

  24. Echenne B, Dulac O, Parayre-Chanez MJ, et al. Treatment of infantile spasms with intravenous gammaglobulins. Brain Dev 1991; 13: 313–9

    Article  PubMed  CAS  Google Scholar 

  25. Bedini R, Feo MR, Orano A, et al. Effects of gammaglobulin therapy in severely epileptic children. Epilepsia 1985; 26: 98–102

    Article  PubMed  CAS  Google Scholar 

  26. Sandstedt P, Kostulas V, Larsson LE. Intravenous gammaglobulin for post-encephalitic epilepsy. Lancet 1984; 8412: 1154–5

    Article  Google Scholar 

  27. Etzioni A, Jaffe M, Pollack S, et al. High dose intravenous gammaglobulin in intractable epilepsy of childhood. Eur J Pediatr 1991; 150: 681–3

    Article  PubMed  CAS  Google Scholar 

  28. Van Rijckevorsel-Harmant K, Delire M, Rucquoy-Ponsar M. Treatment of idiopathic West and Lennox-Gastaut syndromes by intravenous administration of human polyvalent immunoglobulins. Eur Arch Psychiatry Clin Neurosci 1986; 236: 119–22

    Google Scholar 

  29. Motoyama K, Baba K, Yanagi T, et al. Intravenous immunoglobulin for intractable seizures in severely handicapped children, its efficacy on seizures and immunity. No To Hattatsu 1987; 19: 275–80

    PubMed  CAS  Google Scholar 

  30. Ariizumi M, Baba K, Hibio S, et al. Immunoglobulin therapy in the West syndrome. Brain Dev 1987; 8: 422–5

    Article  Google Scholar 

  31. Özdirim E, Aysun S, Topçu M, et al Intravenous gamma globulin treatment in intractable epilepsy [abstract]. Pediatr Neurol 1994; 11: 162

    Article  Google Scholar 

  32. Gross-Tsur V, Shinnar S. Discontinuing antiepileptic drug treatment. In: Wyllie E, editor. The treatment of epilepsy, principles and practice. Philadelphia: Lea & Febiger, 1993: 858–66

    Google Scholar 

  33. Plebani A, Duse M, Tiberti S, et al. Intravenous γ globulin therapy and serum IgG subclass levels in intractable childhood epilepsy. Monogr Allergy 1988: 23: 204–15

    PubMed  CAS  Google Scholar 

  34. Annegers JF, Hauser WA, Elveback LR. Remission of seizures and relapse in patients with epilepsy. Epilepsia 1979; 20: 729–37

    Article  PubMed  CAS  Google Scholar 

  35. Levinson AI. The use of IVIG in neurological disease. Clin Rev Allergy 1992; 10: 119–34

    PubMed  CAS  Google Scholar 

  36. Hirayama H, Kurimoto T, Wada S, et al. Anti-epileptic effects of globulin-N, an intact human immunoglobulin and its tissue-distribution in kindled cats. Int J Clin Pharmacol Ther Toxicol 1986; 24: 109–22

    PubMed  CAS  Google Scholar 

  37. ASHP therapeutic guidelines for intravenous immune globulin. Clin Pharm 1992; 11: 117–36

  38. Dulac O, Schlumberger E. Treatment of West syndrome. In: Wyllie E, editor. The treatment of epilepsy, principles and practice. Philadelphia: Lea & Febiger, 1993: 595–603

    Google Scholar 

  39. Kalviainen R, Keranen T, Riekknen PJ. Place of newer antiepileptic drugs in the treatment of of epilepsy. Drugs 1993; 43: 1009–24

    Article  Google Scholar 

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Authors and Affiliations

  1. Neuropediatric Unit and Florence Miller EEG Unit, Shaare Zedek Medical Center, POB 3235, Jerusalem, 91031, Israel

    Varda Gross-Tsur & Ruth S. Shalev

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  1. Varda Gross-Tsur
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  2. Ruth S. Shalev
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Gross-Tsur, V., Shalev, R.S. The Potential of Immunoglobulin Therapy in Intractable Seizures. CNS Drugs 3, 83–89 (1995). https://doi.org/10.2165/00023210-199503020-00001

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