1
|
Dziadkowiak E, Moreira H, Buska-Mach K, Szmyrka M, Budrewicz S, Barg E, Janik M, Pokryszko-Dragan A. Occult Autoimmune Background for Epilepsy-The Preliminary Study on Antibodies Against Neuronal Surface Antigens. Front Neurol 2021; 12:660126. [PMID: 34744955 PMCID: PMC8567837 DOI: 10.3389/fneur.2021.660126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of the study was to determine the incidence of antibodies against neuronal surface antigens (NSA-ab) in patients with different types of epilepsy, in comparison with the subjects diagnosed with immune-mediated disorders. Methods: Forty patients with drug-resistant epilepsy (DRE) of unknown origin, 16 with post-stroke epilepsy, and 23 with systemic autoimmune disorders (SAD) with CNS involvement were included. NSA-ab were sought in serum using indirect immunofluorescence method. Relationships were analyzed between presence of NSA-ab and clinical presentation. Results: NSA-ab was detected in the sera from five patients: anti-DPPX in one patient, anti-AMPAR1/R2 in two, anti-LGI1 in one and, in one case, both anti-CASPR2 and DPPX IgG. Out of these five patients, three represented the SAD subgroup and two the DRE subgroup. None of the patients with post-stroke epilepsy was positive for NSA-ab. Significance: Autoimmune etiology is worth considering in patients with drug-resistant epilepsy of unknown origin. The presence of NSA-ab in patients with systemic autoimmune disorders may be caused by unspecifically enhanced autoimmune reactivity. NSA-ab seem not to be related to epilepsy resulting from ischemic brain injury.
Collapse
Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Helena Moreira
- Department of Basic Medical Sciences, Wroclaw Medical University, Wroclaw, Poland
| | | | - Magdalena Szmyrka
- Department of Rheumatology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Ewa Barg
- Department of Basic Medical Sciences, Wroclaw Medical University, Wroclaw, Poland
| | | | | |
Collapse
|
2
|
Duse M, Notarangelo LD, Tiberti S, Menegati E, Plebani A, Ugazio AG. Intravenous immune globulin in the treatment of intractable childhood epilepsy. Clin Exp Immunol 2019. [DOI: 10.1111/cei.1996.104.s1.71] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
3
|
Follow-Up of Peripheral IL-1β and IL-6 and Relation with Apoptotic Death in Drug-Resistant Temporal Lobe Epilepsy Patients Submitted to Surgery. Behav Sci (Basel) 2018; 8:bs8020021. [PMID: 29401729 PMCID: PMC5836004 DOI: 10.3390/bs8020021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 12/11/2022] Open
Abstract
Increasing amounts of evidence support the role of inflammation in epilepsy. This study was done to evaluate serum follow-up of IL-1β and IL-6 levels, as well as their concentration in the neocortex, and the relationship of central inflammation with NF-κB and annexin V in drug-resistant temporal lobe epileptic (DRTLE) patients submitted to surgical treatment. Peripheral and central levels of IL-1β and IL-6were measured by ELISA in 10 DRTLE patients. The sera from patients were taken before surgery, and 12 and 24 months after surgical treatment. The neocortical expression of NF-κB was evaluated by western blotting and annexin V co-localization with synaptophysin by immunohistochemistry. The neocortical tissues from five patients who died by non-neurological causes were used as control. Decreased serum levels of IL-1 and IL-6 were observed after surgery; at this time, 70% of patients were seizure-free. No values of IL-1 and IL-6 were detected in neocortical control tissue, whereas cytokine levels were evidenced in DRTLE. Increased NF-κB neocortex expression was found and the positive annexin V neurons were more obvious in the DRTLE tissue, correlating with IL-6 levels. The follow-up study confirmed that the inflammatory alterations disappeared one year after surgery, when the majority of patients were seizure-free, and the apoptotic death process correlated with inflammation.
Collapse
|
4
|
Bello-Espinosa LE, Rajapakse T, Rho JM, Buchhalter J. Efficacy of intravenous immunoglobulin in a cohort of children with drug-resistant epilepsy. Pediatr Neurol 2015; 52:509-16. [PMID: 25882078 DOI: 10.1016/j.pediatrneurol.2014.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/15/2014] [Accepted: 11/18/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We describe the experience of a pediatric epilepsy center regarding the efficacy of intravenous immunoglobulin for drug-resistant seizures in children. METHODS A retrospective chart review of all children in a community-based, children's hospital neurology clinic from 2006 to 2012, inclusive, with intractable epilepsy who were treated with intravenous immunoglobulin for a minimum of six cycles was performed. Data collected included patient demographics, seizure and epilepsy syndrome type, presumed etiology for the seizures, and seizure frequency. Response to intravenous immunoglobulin was defined as "positive" if either seizure freedom or ≥50% reduction of seizures was achieved. RESULTS Twenty-seven children (3-17 years old) were identified and included in the analysis. Following treatment with intravenous immunoglobulin, the following outcomes were noted: four were seizure-free, eight had 90% reduction, five had 75% reduction, and five had 50% reduction. A total of 22 (81%) patients had a positive clinical response to treatment from baseline. Five patients (19%) were not responsive. No clear relationship of responsiveness to intravenous immunoglobulin with regard to age, gender, or epilepsy syndrome was apparent; however, the small numbers in each category precluded meaningful statistical analysis. SIGNIFICANCE Our findings and those of others suggest that intravenous immunoglobulin is a potentially high efficacy, low side effect profile therapy in the treatment of children with drug-resistant epilepsies. Intravenous immunoglobulin was able to reduce multiple seizure types in a variety of epilepsy etiologies, including those of unknown cause.
Collapse
Affiliation(s)
- Luis E Bello-Espinosa
- Department of Pediatrics, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Thilinie Rajapakse
- Department of Pediatrics, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Jong M Rho
- Department of Pediatrics, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Jeffrey Buchhalter
- Department of Pediatrics, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada.
| |
Collapse
|
5
|
Abstract
The role of immunity and inflammation appears to be an integral part of the pathogenic processes associated with some seizures, particularly with refractory epilepsy. Prompt treatment with immunotherapy may lead to better outcomes. Immune treatment options for treatment of epilepsy include therapies such as corticosteroids, immunoglobulins, plasmapheresis, or steroid-sparing drugs such as azathioprine. Recent alternatives have included even more aggressive treatment with cyclophosphamide, anti-pre-B-lymphocyte monoclonal antibody rituximab, and monoclonal antibodies such as efalizumab or natalizumab, which are presently used for other inflammatory disorders. Randomized controlled trials of immunotherapy in presumed autoimmune epilepsy are needed to provide further support for the rapid use of immunotherapy in patients with immune mediated epilepsy.
Collapse
Affiliation(s)
- Joseph J Melvin
- Section of Neurology, St. Christopher's Hospital for Children, Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA..
| | - H Huntley Hardison
- Section of Neurology, St. Christopher's Hospital for Children, Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA
| |
Collapse
|
6
|
Yu N, Liu H, Di Q. Modulation of Immunity and the Inflammatory Response: A New Target for Treating Drug-resistant Epilepsy. Curr Neuropharmacol 2013; 11:114-27. [PMID: 23814544 PMCID: PMC3580785 DOI: 10.2174/157015913804999540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 07/16/2012] [Accepted: 11/17/2012] [Indexed: 12/11/2022] Open
Abstract
Until recently, epilepsy medical therapy is usually limited to anti-epileptic drugs (AEDs). However, approximately 1/3 of epilepsy patients, described as drug-resistant epilepsy (DRE) patients, still suffer from continuous frequent seizures despite receiving adequate AEDs treatment of sufficient duration. More recently, with the remarkable progress of immunology, immunity and inflammation are considered to be key elements of the pathobiology of epilepsy. Activation of inflammatory processes in brain tissue has been observed in both experimental seizure animal models and epilepsy patients. Anti-inflammatory and immunotherapies also showed significant anticonvulsant properties both in clinical and in experimental settings. The above emerging evidence indicates that modulation of immunity and inflammatory processes could serve as novel specific targets to achieve potential anticonvulsant effects for the patients with epilepsy, especially DRE. Herein we review the recent evidence supporting the role of inflammation in the development and perpetuation of seizures, and also discuss the recent achievements in modulation of inflammation and immunotherapy applied to the treatment of epilepsy. Apart from medical therapy, we also discuss the influences of surgery, ketogenic diet, and electroconvulsive therapy on immunity and inflammation in DRE patients. Taken together, a promising perspective is suggested for future immunomodulatory therapies in the treatment of patients with DRE.
Collapse
Affiliation(s)
- Nian Yu
- Department of Neurology, Nanjing Brain Hospital affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | | | | |
Collapse
|
7
|
Abstract
Lennox-Gastaut syndrome (LGS) is a rare, age-related syndrome, characterized by multiple seizure types, a specific electro-encephalographic pattern, and mental regression. However, published data on the etiology, evolution, and therapeutic approach of LGS are contradictory, partly because the precise definition of LGS used in the literature varies. In the most recent classification, LGS belongs to the epileptic encephalopathies and is highly refractory to all antiepileptic drugs. Numerous treatments, medical and non-medical, have been proposed and results mostly from open studies or case series have been published. Sometimes, patients with LGS are included in a more global group of patients with refractory epilepsy. Only 6 randomized double-blind controlled trials of medical treatments, which included patients with LGS, have been published. Overall, treatment is rarely effective and the final prognosis remains poor in spite of new therapeutic strategies. Co-morbidities need specific treatment. This paper summarizes the definition, diagnosis and therapeutic approach to LGS, including not only recognized antiepileptic drugs, but also "off label" medications, immune therapy, diet, surgery and some perspectives for the future.
Collapse
Affiliation(s)
- Kenou van Rijckevorsel
- Reference Centre of Refractory Epilepsy, Cliniques Universitaires St Luc, Université Catholique de Louvain, Avenue Hippocrate, 10, B-1200 Brussels, Belgium.
| |
Collapse
|
8
|
Billiau AD, Witters P, Ceulemans B, Kasran A, Wouters C, Lagae L. Intravenous Immunoglobulins in Refractory Childhood-Onset Epilepsy: Effects on Seizure Frequency, EEG Activity, and Cerebrospinal Fluid Cytokine Profile. Epilepsia 2007; 48:1739-1749. [PMID: 17521345 DOI: 10.1111/j.1528-1167.2007.01134.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Several studies have reported favorable effects of intravenous immunoglobulins (IVIG) in refractory epilepsy. Evidence substantiating an immunomodulatory action is scarce. In an open-label study, we prospectively investigated the effect of IVIG on clinical, EEG and serum/CSF immunological parameters in patients with refractory childhood-onset epilepsy. METHODS Thirteen patients (median age 6.9 years; range 1.6-25.8) with refractory seizures despite 3-4 antiepileptic drug regimens were given IVIG (Sandoglobulin, ZLB-Behring, add-on, 4 x 400 mg/kg/3 weeks). Seizure frequency, 24-h video-EEG, and CSF/serum immunological parameters and cytokine profiles (IL-6/IL-8/IL-12/IL-10) were documented before and after completion of the course. RESULTS Seizure frequency was reduced by > or = 50% in four, and by 25%-50% in three patients. In contrast, variation in automatically recorded spike counts (1-h-wake and -sleep) did not correlate with clinical improvement. Serum immunological parameters showed variable deviations in eight patients (e.g., IgG(2) deficiency) and CSF immunoblotting showed oligoclonal bands in two patients. Blood-brain barrier permeability was normal in 12 patients. IL-6 and IL-8 were clearly detectable in CSF of all patients; the levels were significantly higher than those in plasma but remained unaffected by IVIG treatment. CONCLUSIONS Despite unchanged EEG spike counts, substantial reductions in seizure frequency occurred in 7 of 13 patients, suggesting that IVIG hinder progression of central epileptic activity into clinical seizures. Intrathecal presence of IL-8 and IL-6 was documented in all patients, but was unaffected by IVIG, suggesting that their production is directly related to electrical seizure activity and that IVIG may act through interference with immune pathways downstream to IL-6 and IL-8.
Collapse
Affiliation(s)
- An D Billiau
- Laboratory of Experimental Transplantation, University of Leuven, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumLab of Experimental Immunology, KULeuven, Leuven, Belgium
| | - Peter Witters
- Laboratory of Experimental Transplantation, University of Leuven, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumLab of Experimental Immunology, KULeuven, Leuven, Belgium
| | - Berten Ceulemans
- Laboratory of Experimental Transplantation, University of Leuven, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumLab of Experimental Immunology, KULeuven, Leuven, Belgium
| | - Ahmad Kasran
- Laboratory of Experimental Transplantation, University of Leuven, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumLab of Experimental Immunology, KULeuven, Leuven, Belgium
| | - Carine Wouters
- Laboratory of Experimental Transplantation, University of Leuven, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumLab of Experimental Immunology, KULeuven, Leuven, Belgium
| | - Lieven Lagae
- Laboratory of Experimental Transplantation, University of Leuven, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumPediatric Rheumatology, University Hospital Gasthuisberg, Leuven, BelgiumLab of Experimental Immunology, KULeuven, Leuven, Belgium
| |
Collapse
|
9
|
Abstract
Great progress has been made in the last 150 years in the pharmacological management of epilepsy, and, despite the increasing number of technological advances available, antiepileptic drugs (AEDs) remain the mainstay of treatment for the vast majority of patients with epilepsy. This review looks at possible avenues of development in the drug treatment of epilepsy. The strengths and weaknesses of those AEDs which are currently licensed are examined, and ways in which their use may be improved are discussed (e.g. rational combinations, use of new formulations). Potentially new targets that may allow the development of effective treatments are highlighted (neuroimmunological manipulation, decreasing inherent drug resistance mechanisms, and modification of adenosine neurotransmission), and a summary of the most promising AEDs currently in development is provided [e.g. carabersat, ganaxolone, harkoseride, MDL 27192, safinamide (NW 1015), pregabalin, retigabine, talampanel, valrocemide, losigamone and BIA 2093].
Collapse
Affiliation(s)
- A Nicolson
- Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | | |
Collapse
|
10
|
van Engelen BG, Renier WO, Weemaes CM, Gabreels FJ, Meinardi H. Immunoglobulin treatment in epilepsy, a review of the literature. Epilepsy Res 1994; 19:181-90. [PMID: 7698094 DOI: 10.1016/0920-1211(94)90061-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this study is to ascertain possible efficacy and to understand possible mechanisms of action of intramuscular or intravenous immunoglobulin (IVIg) in the treatment of intractable epilepsy, through a review of all identifiable articles on this topic. In 24 studies, none with a placebo controlled design, 368 patients with epilepsy receiving IVIg were identified. Patients' ages ranged from < 1 to 35 years, mean 7.3 years. Female/male ratio was 0.6. All patients were reported to suffer from intractable epilepsy. The average percentage of patients with an IgG2 deficiency was 25%. The total dose of IVIg varied between 0.3 and 6.8 g/kg for a period of 0.15 to 12 months. Whenever reported, adverse effects of IVIg were minimal. None of the studies reported the need of cessation of IVIg administration due to adverse effects. On the average, the mean clinical seizure reduction and the mean EEG improvement were 52% and 45%, respectively. On the average the percentage of patients with complete seizure remission and the percentage of patients with behavioral improvement were 23% and 63%, respectively. Cumulative meta-analysis of the identified articles is not possible due to the lack of controlled studies, the heterogeneity of the available studies, and the possible publication bias of unpublished negative data. Given these pitfalls, this literature study nevertheless allows some conclusions: (i) There is no formal proof of efficacy of IVIg treatment in epilepsy, and the present review underscores the need of controlled clinical trials before firm conclusions concerning efficacy can be drawn. The uncontrolled clinical observations discussed in this 'state-of-the-art' review generate suggestive evidence at best. They suggest that IVIg might be effective in some patients with intractable epilepsy, and may be considered as a safe add-on medication in various types of idiopathic and symptomatic intractable epilepsy. (ii) Review of the literature did not help in explaining intractable epilepsy or the mechanism of action of IVIg, but did permit some inferences that could serve to design future clinical and experimental approaches to IVIg administration in epilepsy.
Collapse
Affiliation(s)
- B G van Engelen
- Institute of Neurology, University Hospital Nijmegen, The Netherlands
| | | | | | | | | |
Collapse
|