Background

Up to 40% of people with epilepsy continue to have seizures despite anti-seizure medications. In these cases, there is a desperate need for new treatment approaches. Following recent advances in our understanding of the blood-brain barrier (BBB) and the immune system’s role in propagating seizures, we set out to investigate whether immunotherapy, such as high-dose steroids or intravenous immunoglobulin (IVIG), treatments which repair the BBB and modulate the immune system, would reduce seizures.

Research

This study examined the treatment response of 31 patients with highly active refractory epilepsy who received treatment with immunotherapy in addition to their usual antiseizure medications. Nine patients (29%) demonstrated a sustained treatment response, measured as a greater than 50% improvement in seizure frequency for at least 12 months. Three patients (10%) became seizure-free. Six patients (20%) were classified as partial responders and experienced an initial response that was not sustained. Apart from a trend toward a diagnosis of focal epilepsy, we did not identify any specific patient characteristics that were predictive of treatment response.

Potential Impact

These findings demonstrate a surprising and significant reduction in seizures among a portion of highly active and refractory epilepsy patients for the first time. This supports considering such treatment in this patient group. The exact mechanism for this treatment response and the reason why it occurred in only some patients remain unclear. As such, we are undertaking a follow-on study where BBB integrity and immune function are closely examined before and after treatment using MRI and blood testing.