Intravenous immunoglobulin therapy in intractable childhood epilepsy: Open-label study and review of the literature

• Published in: Epilepsy & behavior Vol. 17; no. 1; pp. 90 - 94
• Main Authors: Mikati, Mohamad A, Kurdi, Rana, El-Khoury, Ziad, Rahi, Amal, Raad, Wissam
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2010
• Subjects: Adolescent; Child; Child, Preschool; Epilepsy; Epilepsy - classification; Epilepsy - drug therapy; Epilepsy - physiopathology; Female; Generalized seizures; Humans; Immunoglobulins, Intravenous - administration & dosage; Immunologic Factors - administration & dosage; Infantile spasms; Intravenous gamma globulin; Lennox–Gastaut syndrome; Longitudinal Studies; Male; Multivariate Analysis; Neurology; Partial seizures; Therapy; West syndrome; Young Adult; Therapy; West syndrome; Infantile spasms; Epilepsy; Generalized seizures; Lennox–Gastaut syndrome; Child; Partial seizures; Intravenous gamma globulin
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2009.10.020

Abstract Our aim was to investigate the long term effectiveness of intravenous immunoglobulin (IVIG) against intractable childhood epilepsy in the era of new antiepileptics and to determine the predictors of a favorable response in a prospective open-label add-on study. Of thirty-seven 9.9 ± 0.9-year-old patients (11 with partial seizures, 26 with generalized seizures of whom 9 had West syndrome and 17 Lennox–Gastaut syndrome) followed for 15 ± 3 months, 43% had a >50% decrease in seizures (including 15% seizure free, 229 ± 58 compared with 104 ± 3 seizures/month, P = 0.035: generalized 246 ± 318 to 117 ± 200, P = 0.025, partial 191 ± 437 to 72 ± 179, P > 0.05; power = 0.2). Males were more likely to respond than females ( P = 0.011, odds ratio = 9.3). Review of the literature revealed nine other articles reporting efficacy of IVIG against epileptic seizures. Only one other used statistical methods and, unlike ours, showed only a trend toward seizure frequency reduction without achieving statistical significance, presumably because it was underpowered. These results indicate large-scale controlled studies of IVIG in epilepsy are still needed.