Utility of an immunothera

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Objective: To evaluate a trial of immunotherapy as an aid to diagnosis in suspected autoimmune epilepsy. Method: We reviewed the charts of 110 patients seen at our autoimmune neurology clinic with seizures as a chief complaint. Twenty-nine patients met the following inclusion criteria: (1) autoimmune epilepsy suspected based on the presence of ≥1 neural autoantibody (n = 23), personal or family history or physical stigmata of autoimmunity, and frequent or medically intractable seizures; and (2) initiated a 6- to 12-week trial of IV methylprednisolone (IVMP), IV immune globulin (IVIg), or both. Patients were defined as responders if there was a 50% or greater reduction in seizure frequency. Results: Eighteen patients (62%) responded, of whom 10 (34%) became seizure-free; 52% improved with the first agent. Of those receiving a second agent after not responding to the first, 43% improved. A favorable response correlated with shorter interval between symptom onset and treatment initiation (median 9.5 vs 22 months; p = 0.048). Responders included 14/16 (87.5%) patients with antibodies to plasma membrane antigens, 2/6 (33%) patients seropositive for glutamic acid decarboxylase 65 antibodies, and 2/6 (33%) patients without detectable antibodies. Of 13 responders followed for more than 6 months after initiating long-term oral immu-nosuppression, response was sustained in 11 (85%). Conclusions: These retrospective findings justify consideration of a trial of immunotherapy in patients with suspected autoimmune epilepsy. Classification of evidence: This study provides Class IV evidence that in patients with suspected autoimmune epilepsy, IVMP, IVIg, or both improve seizure control.

Original languageEnglish (US)
Pages (from-to)1578-1586
Number of pages9
JournalNeurology
Volume82
Issue number18
DOIs
StatePublished - May 6 2014

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Seizures
Epilepsy
Methylprednisolone
Immunotherapy
Antibodies
Immunoglobulins
Christianity
Glutamate Decarboxylase
Neurology
Autoimmunity
Autoantibodies
Cell Membrane
Antigens
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Toledano, M., Britton, J. W., McKeon, A. B., Shin, C., Lennon, V. A., Quek, A. M. L., ... Pittock, S. J. (2014). Utility of an immunothera. Neurology, 82(18), 1578-1586. https://doi.org/10.1212/WNL.0000000000000383

Utility of an immunothera. / Toledano, M.; Britton, J. W.; McKeon, Andrew B; Shin, C.; Lennon, Vanda A; Quek, A. M L; So, E.; Worrell, Gregory Alan; Cascino, Gregory D; Klein, Christopher Jon; Lagerlund, T. D.; Wirrell, Elaine C; Nickels, Katherine C; Pittock, Sean J.

In: Neurology, Vol. 82, No. 18, 06.05.2014, p. 1578-1586.

Research output: Contribution to journalArticle

Toledano M, Britton JW, McKeon AB, Shin C, Lennon VA, Quek AML et al. Utility of an immunothera. Neurology. 2014 May 6;82(18):1578-1586. https://doi.org/10.1212/WNL.0000000000000383
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