title: Treatment of immune-mediated temporal lobe epilepsy with GAD antibodies.
abstract: OBJECTIVE
  Temporal lobe epilepsy with antibodies (abs) against the glutamic acid decarboxylase 65 isoform (GAD-TLE) is known as an immune-mediated neurological syndrome. Here we evaluate the therapy response to various immunotherapies and epilepsy surgery in this syndrome.
  
  
  METHODS
  All patients with GAD-TLE and follow-up data and stored serum and CSF samples, identified and treated at the Bonn centre from 2002 to 2010, were studied retrospectively. Seizure freedom for ≥1 year and reduction of ≥50%, i.e. therapy response, were assessed. GAD-ab titres and neuropsychological performances were documented prior and after individual interventions.
  
  
  RESULTS
  Thirteen patients with GAD-TLE were identified with the following seizure responses: corticosteroids (5 responders out of 11 treated patients); i.v. immunoglobulins (1/5), apheresis therapy (1/8); and natalizumab (1/1), selective amygdala-hippocampectomy (2/3). None of the patients achieved sustained seizure freedom apart from one patient. This patient was on antiepileptic drug treatment after discontinuation of immunotherapy.
  
  
  CONCLUSIONS
  The seizure response to immunotherapies in patients with GAD-TLE was poor. Corticosteroids were the most effective regarding seizure response. Especially the poor effects of apheresis therapies support the idea that GAD-abs are not directly pathogenic. None of three patients was seizure-free after temporal lobe surgery suggesting that GAD-TLE patients respond worse than others to this type of intervention. Our results reflect the chronic course of the disease with low likelihood for patients with GAD-TLE to attain long-term seizure freedom.
authors.affiliation: University of Bonn Medical Centre, Department of Epileptology, Germany; University Hospital Cologne, Department of Neurology, Germany. Electronic address: michael.malter@gmx.de.
authors.forename: M P
authors.initials: MP
authors.lastname: Malter
authors.affiliation: University of Bonn Medical Centre, Department of Epileptology, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Frisch
authors.affiliation: University of Bonn Medical Centre, Department of Internal Medicine, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Zeitler
authors.affiliation: University of Bonn Medical Centre, Department of Epileptology, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Surges
authors.affiliation: University Medical Centre Freiburg, Department of Neuroradiology, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Urbach
authors.affiliation: University of Bonn Medical Centre, Department of Epileptology, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Helmstaedter
authors.affiliation: University of Bonn Medical Centre, Department of Epileptology, Germany.
authors.forename: C E
authors.initials: CE
authors.lastname: Elger
authors.affiliation: University of Bonn Medical Centre, Department of Epileptology, Germany; Epilepsy Centre Bethel, Krankenhaus Mara, Bielefeld, Germany.
authors.forename: C G
authors.initials: CG
authors.lastname: Bien
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood*; D020274:Autoimmune Diseases of the Nervous System / Q000097:blood / Q000134:cerebrospinal fluid / Q000628:therapy*; D002648:Child; D004833:Epilepsy, Temporal Lobe / Q000097:blood / Q000134:cerebrospinal fluid / Q000276:immunology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005968:Glutamate Decarboxylase / Q000276:immunology*; D006801:Humans; D007167:Immunotherapy; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D001323:Autoantibodies; D005968:Glutamate Decarboxylase; C401141:glutamate decarboxylase 2; D008775:Methylprednisolone
keywords: Autoimmune epilepsy; GAD-abs; Temporal lobe epilepsy