Intravenous high-dose gammaglobulins for intractable childhood epilepsy.
Immunological mechanisms have been implicated in the pathogenesis of epileptic seizures in some patients and in experimental animal models of epilepsy. A beneficial effect of high dose intravenous gammaglobulin (IVIG) has been demonstrated for some children with intractable epilepsy. In this study we treated 9 children ages 1.1-9.2 years (mean 5.0 years) with intractable epilepsy not responsive to conventional antiepileptic drugs (AEDs) and steroid therapy. Eight children had Lennox-Gastaut syndrome and 1 had complex partial seizures with secondary generalization. Each child received 3 doses of IVIG (200 mg/kg of polyvalent immunoglobulin) on Days 1, 15 and 36. Concomitant AEDs were not changed. Four children had complete remission, 3 had partial response with a more than 50% reduction in seizure frequency and 2 had no response. Onset of response varied from immediate to 7 months after the last injection. No toxicity was noted. Duration of remission was 9 months in 1 case. The other 3 cases have remained in remission to date with a follow up period of 22-26 months. We conclude that IVIG is a safe therapy which appears to be effective in some children with intractable seizures. Children with shorter duration of their seizure disorder (< 1 year) and relatively preserved cognitive function (IQ > 70) appear to have a more favorable response. Larger scale controlled trials are needed to determine the optimal timing and dosage, as well as to identify specific subgroups which may benefit most from IVIG treatment.
Gross-Tsur
V
V
Florence Miller EEG Diagnostic Unit, Neuropediatric Unit Shaare Zedek Medical Center, Jerusalem, Israel.
Shalev
R S
RS
Kazir
E
E
Engelhard
D
D
Amir
N
N
D002648:Child; D002675:Child, Preschool; D004306:Dose-Response Relationship, Immunologic; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D017286:Polysomnography; D012895:Sleep, REM; D016896:Treatment Outcome; D005719:gamma-Globulins / Q000008:administration & dosage / Q000627:therapeutic use*
D007074:Immunoglobulin G; D005719:gamma-Globulins