[P3-46] The Effectiveness Of Steroid Pulse Therapy And Prognosis In Frontal Lobe Epilepsy With Anti-glutamate Receptor Antibodies : A Case Report.
[Background] Recent reports have shown that autoimmunity is involved in the epileptogenic acquisition process and that steroid and immunoglobulin therapies are effective. We report a patient with refractory frontal lobe epilepsy who was positive for anti-glutamate receptor (GluR) antibodies. Steroid pulse therapy (SPT) was successful and allowed for the discontinuation of medication. [Patient and Methods] The patient was a 16-year-old female. Since eight years old, she exhibited complex partial seizures. She had seizures every day, and each episodes lasted approximately 10 seconds. The frequency of her seizures slowly increased. EEGs revealed frequent sharp waves on predominant bilateral frontal area, periodic generalized spike-and-wave complexes, and sharp waves. Although most antiepileptic drugs were ineffective, the seizures disappeared and the EEGs improved after SPT. Seven months after onset, her serum and cerebrospinal fluid (CSF) were positive for the IgM-ε2 and IgG-ε2 anti-GluR antibodies, respectively. Ten months after onset, her serum was positive for IgG-ε2, and her CSF was negative. Her seizures had been suppressed for a long period and she exhibited no sequelae. The antiepileptic drugs were discontinued when she was 16 years old. Since discontinuation of the medication, she has been no seizures and no abnormalities in EEG. [Discussion] Though anti GluR antibodies are not significant specific disease marker, the presence of antibodies gives the suggestion of pathological mechanism and the choice of effective treatments. Autoimmune mechanisms are involved in some cases of refractory epilepsy, and early immunotherapy interventions at the appropriate time are thought to contribute to good prognoses.