IVIg

The occurrence of seizures in systemic immune-mediated disorders demonstrates that epilepsy can be related to immunologic disorders. This raises the issues of whether immune mechanisms may be important in other, more common forms of epilepsy and whether immunotherapy merits further consideration.

Immunoglobulin therapy was first reported to be effective in epilepsy in 1977, when children with epilepsy were given intramuscular IgG to treat recurrent upper respiratory tract infections. Improvements in seizure frequency and behavior were noted. Subsequently, 16 children with Lennox-Gastaut syndrome were treated with intravenous IgG (IVIG), and significant improvement was seen in 8 of them. Since that time, several additional clinical trials have been published with similar results, reporting significant improvement in about half of cases.

In 1994, the first double-blind, placebo-controlled trial of IVIG for the treatment of epilepsy was published. Three different dosages were evaluated in 61 patients with intractable epilepsy of various etiologies. Significant clinical improvement, defined as a reduction in seizures by at least 50% after 6 months, was reported in 52.5% of the IVIG group, compared to 27.8% of the placebo group, with a p value of .095. No dose relationship was identified.

There is emerging clinical evidence that IVIG may be of value in several refractory seizure conditions, including Doose Syndrome. The details regarding which patients and at what point of the illness it should be used need to be investigated further.

Adapted from: Seiden L and Krumholz A. Inflammatory noninfectious disorders. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;135-154.