M P Malter1, C Frisch2, H Zeitler3, R Surges2, H Urbach4, C Helmstaedter2, C E Elger2, C G Bien5. 1. University of Bonn Medical Centre, Department of Epileptology, Germany; University Hospital Cologne, Department of Neurology, Germany. Electronic address: michael.malter@gmx.de. 2. University of Bonn Medical Centre, Department of Epileptology, Germany. 3. University of Bonn Medical Centre, Department of Internal Medicine, Germany. 4. University Medical Centre Freiburg, Department of Neuroradiology, Germany. 5. University of Bonn Medical Centre, Department of Epileptology, Germany; Epilepsy Centre Bethel, Krankenhaus Mara, Bielefeld, Germany.
Abstract
PURPOSE: Temporal lobe epilepsy with antibodies (abs) against the glutamic acid decarboxylase 65 isoform (GAD-TLE) is known as an immune-mediated neurological syndrome. Here we evaluate the therapy response to various immunotherapies and epilepsy surgery in this syndrome. METHOD: All patients with GAD-TLE and follow-up data and stored serum and CSF samples, identified and treated at the Bonn centre from 2002 to 2010, were studied retrospectively. Seizure freedom for ≥1 year and reduction of ≥50%, i.e. therapy response, were assessed. GAD-ab titres and neuropsychological performances were documented prior and after individual interventions. RESULTS: Thirteen patients with GAD-TLE were identified with the following seizure responses: corticosteroids (5 responders out of 11 treated patients); i.v. immunoglobulins (1/5), apheresis therapy (1/8); and natalizumab (1/1), selective amygdala-hippocampectomy (2/3). None of the patients achieved sustained seizure freedom apart from one patient. This patient was on antiepileptic drug treatment after discontinuation of immunotherapy. CONCLUSION: The seizure response to immunotherapies in patients with GAD-TLE was poor. Corticosteroids were the most effective regarding seizure response. Especially the poor effects of apheresis therapies support the idea that GAD-abs are not directly pathogenic. None of three patients was seizure-free after temporal lobe surgery suggesting that GAD-TLE patients respond worse than others to this type of intervention. Our results reflect the chronic course of the disease with low likelihood for patients with GAD-TLE to attain long-term seizure freedom.
PURPOSE:Temporal lobe epilepsy with antibodies (abs) against the glutamic acid decarboxylase 65 isoform (GAD-TLE) is known as an immune-mediated neurological syndrome. Here we evaluate the therapy response to various immunotherapies and epilepsy surgery in this syndrome. METHOD: All patients with GAD-TLE and follow-up data and stored serum and CSF samples, identified and treated at the Bonn centre from 2002 to 2010, were studied retrospectively. Seizure freedom for ≥1 year and reduction of ≥50%, i.e. therapy response, were assessed. GAD-ab titres and neuropsychological performances were documented prior and after individual interventions. RESULTS: Thirteen patients with GAD-TLE were identified with the following seizure responses: corticosteroids (5 responders out of 11 treated patients); i.v. immunoglobulins (1/5), apheresis therapy (1/8); and natalizumab (1/1), selective amygdala-hippocampectomy (2/3). None of the patients achieved sustained seizure freedom apart from one patient. This patient was on antiepileptic drug treatment after discontinuation of immunotherapy. CONCLUSION: The seizure response to immunotherapies in patients with GAD-TLE was poor. Corticosteroids were the most effective regarding seizure response. Especially the poor effects of apheresis therapies support the idea that GAD-abs are not directly pathogenic. None of three patients was seizure-free after temporal lobe surgery suggesting that GAD-TLEpatients respond worse than others to this type of intervention. Our results reflect the chronic course of the disease with low likelihood for patients with GAD-TLE to attain long-term seizure freedom.
Authors: Mar Carreño; Christian G Bien; Ali A Asadi-Pooya; Michael Sperling; Petr Marusic; Martin Elisak; Jose Pimentel; Tim Wehner; Rajiv Mohanraj; Juan Uranga; Asier Gómez-Ibáñez; Vicente Villanueva; Francisco Gil; Antonio Donaire; Nuria Bargalló; Jordi Rumià; Pedro Roldán; Xavier Setoain; Luis Pintor; Teresa Boget; Eva Bailles; Mercè Falip; Javier Aparicio; Josep Dalmau; Francesc Graus Journal: Epilepsy Res Date: 2016-12-15 Impact factor: 3.045
Authors: L Ernst; B David; J Gaubatz; I Domínguez-Narciso; G Lüchters; A J Becker; B Weber; E Hattingen; C E Elger; T Rüber Journal: AJNR Am J Neuroradiol Date: 2019-11-14 Impact factor: 3.825