A study published Online First by Archives of Neurology, one of the JAMA/Archives journals, reveals that patients with autoimmune epilepsy are more likely to have improved seizure outcomes if immunotherapy is initiated early.

According to the researchers:

“Antiepileptic drugs (AEDs) are the mainstay of treatment for epilepsy, but seizures continue in one-third of patients despite appropriate AED therapeutic trials. Even in the current era, the etiology of epilepsy often remains unclear.”

Seizures are prevalent in autoimmune neurologic disorders, such as limbic encephalitis.

Amy M. L. Quek, M.B.B.S., of the Mayo Clinic, College of Medicine, Rochester, Minn., and her team collected data from the Mayo Clinic computerized diagnostic index from patients diagnosed with autoimmune epilepsy who were assessed between January 2005 and December 2010 in both the Autoimmune Neurology Clinic and Epilepsy Clinic, in order to assess clinical characteristics and immunotherapy responses in individuals suffering with autoimmune epilepsy.

Of the patient data examined, the researchers found 32 patients eligible for inclusion in the study. All participants of the study had partial seizures, 81% had daily seizures and had failed treatment with 2+ AEDs, while the remaining participants had at least one seizure per month. Despite AED therapy, 27 of the 32 participants received immunotherapy for treatment of persistent seizures.

The authors found that 81% (22 of 27) of the participants reported improvement following immunotherapy after a median follow-up time of 17 months (3-72 months). In addition, the team found that 18 participants were seizure free. 44% (8) of these 18 patients were seizure free within 12 weeks of starting immunotherapy. Although 5 participants did not respond to the treatment, 2 of the 5 showed subsequent improved after the AEDs were changed.

The authors conclude:

“When clinical and serological clues suggest an autoimmune basis for medically intractable epilepsy, early-initiated immunotherapy may improve seizure outcome. Clinical experience suggests that immunotherapy should not be used alone to control seizures but should be used in combination with AEDs to optimize seizure control.”

In an associated report, Gregory K. Bergey, M.D., of the Johns Hopkins University School of Medicine, Baltimore, said:

“The article by Quek et al on autoimmune epilepsy is another reminder that we need to broaden our concept of symptomatic chronic epilepsy from the structural realm into more dynamic processes not limited to acute inflammatory or infectious pathologies (e.g., meningitis or encephalitis).

What is the true scope of autoimmune epilepsy in our populations of drug-resistant epilepsy? This is not known, but certainly at present it is probably being under-diagnosed.”

He concludes:

“Certainly trials as to which immunotherapy (steroids, intravenous immunoglobulin, cyclosporine, rituximab) is best would be ethical. We need an increased appreciation of the potential role of auto-antibodies in refractory epilepsy so we are not overlooking treatable etiologies.”

Written by Grace Rattue