By Elissa Ritt, MAS
In a presentation on the use of IVIG in epilepsy at the 2013 annual meeting of the American Neurological Association, Dr. Michel Toledano from the Mayo Clinic in Rochester, N.Y., asserted that the use of IVIG or intravenous steroids in epileptic patients who don’t respond to conventional drugs can help to determine if their disease is autoimmune in nature. Dr. Toledano studied 29 epilepsy patients who did not respond to conventional therapy and in whom autoimmune epilepsy was suspected. These 29 patients were treated with either IVIG or IV methylprednisolone for six to 12 weeks, and 18 patients had significant responses and 10 became seizure-free. The immunomodulatory therapy was not initiated to cure the disease, but rather to help determine if it was actually autoimmune in nature. Other interesting findings included:
• Half of the patients who initially failed either IVIG or IV steroids showed a response when switched to the other drug.
• Sixteen of the 29 patients tested positive to an antibody that could be responsible for the disease (plasma membrane antigen antibodies). Of these 16, 14 responded to immunomodulatory therapy.
• Time to response suggested that a treatment course of four to six weeks would probably be sufficient.
Dr. Toledano cautioned, however, that a trial with immunomodulatory therapies is not enough to establish a diagnosis of autoimmune epilepsy, since these therapies can reduce the frequency of seizures in patients who have a non-autoimmune type of epilepsy. He also noted that there weren’t enough patients in this study to draw any conclusions about the benefit of immunomodulatory therapy in epilepsy. Therefore, he recommended that a randomized, placebo-controlled crossover study be conducted to assess the usefulness of immunomodulatory therapy in autoimmune epilepsy.
