[P3-49] IVIG For Treatment Resistance Epilepsy in Childhood: A Single Centre Experience
Background: Around 30% of childhood epilepsies fail to respond to antiepileptic medications. Surgery and Ketogenic diet are often considered for these patients. Intravenous immunoglobulin (IVIG) is currently one of the less conventional therapies for epileptic seizures. Recent evidence supports involvement of the immune system in the aetio-pathogenesis of seizures.
Methods: This is a retrospective audit of children treated with IVIG for treatment resistant epilepsy (TREC) at our hospital. Improvement after IVIG was assessed in several domains: seizure frequency, cognition and behavior. Seizure response was graded as: seizure freedom, >90%, 50-90%, <50% reduction, and no response.
Results: Sixteen children (aged 1-15 years, 9 females) received IVIG for TREC. Their diagnoses included Rasmussen encephalitis - 2, West Syndrome-1, Early Infantile epileptic encephalopathy-1, Landau Kleffner syndrome-1, Lennox Gastaut syndrome-1, symptomatic generalized epilepsy- 7, smptomatic focal epilepsy-1, Febrile infection-related epilepsy syndrome-1, and possible autoimmune encephalitis-1. Seizure control improved in 11 with > 50% reduction in 5. One child became seizure free and remained so at follow-up a year later. Three showed >90 % reduction (of whom 2 relapsed), one had >75% seizure reduction (continues on IVIG). Assessment of response was difficult in two with an explosive onset of epilepsy as IVIG was used concurrently with other treatments.
Conclusion: Our experience suggests IVIG has a role in management of TREC. A randomized controlled trial should be performed to evaluate the efficacy and cost effectiveness of IVIG.
Methods: This is a retrospective audit of children treated with IVIG for treatment resistant epilepsy (TREC) at our hospital. Improvement after IVIG was assessed in several domains: seizure frequency, cognition and behavior. Seizure response was graded as: seizure freedom, >90%, 50-90%, <50% reduction, and no response.
Results: Sixteen children (aged 1-15 years, 9 females) received IVIG for TREC. Their diagnoses included Rasmussen encephalitis - 2, West Syndrome-1, Early Infantile epileptic encephalopathy-1, Landau Kleffner syndrome-1, Lennox Gastaut syndrome-1, symptomatic generalized epilepsy- 7, smptomatic focal epilepsy-1, Febrile infection-related epilepsy syndrome-1, and possible autoimmune encephalitis-1. Seizure control improved in 11 with > 50% reduction in 5. One child became seizure free and remained so at follow-up a year later. Three showed >90 % reduction (of whom 2 relapsed), one had >75% seizure reduction (continues on IVIG). Assessment of response was difficult in two with an explosive onset of epilepsy as IVIG was used concurrently with other treatments.
Conclusion: Our experience suggests IVIG has a role in management of TREC. A randomized controlled trial should be performed to evaluate the efficacy and cost effectiveness of IVIG.