(This blog was originally posted on May 27, 2014)
Almost one-third of people who have epilepsy cannot satisfactorily
control their seizures, even when they take several anti-epilepsy drugs
simultaneously.
A new treatment has come to light that some of these epilepsy patients
respond to drugs that reduce inflammation in the brain. Toledano, et. al,
reported that immunotherapy can improve seizure control (Neurology; 82:1578-86, May 6, 2014). How can this work?
Patients’ own natural defenses can cause disease. This type of disease
mechanism is known as an autoimmune process. For various, and poorly understood
reasons, the body creates chemical substances called antibodies that react with,
and battle against, itself. Antibodies normally are produced to fight against
disease-bearing germs, such as those causing infections, and against foreign
bodies. Examples of FOREIGN BODIES are livers and kidneys transplanted from one
person into another. But sometimes the body uses the immune system to harm
itself. Examples of AUTOIMMUNE illnesses include rheumatoid arthritis, lupus,
myasthenia gravis and multiple sclerosis.
Various inflammations of the brain are also caused by autoimmune
antibody mechanisms. Autoimmune diseases are treated with medications that
minimize the effect of autoimmune antibodies. Steroids (prednisone,
methylprednisolone, and cortisol) are examples of such medications. Other
treatments involve “washing” these deleterious antibodies out of the blood by
plasmapheresis, or by infusing intravenously human immune
globulin (IVIG) blood products. The precise mechanism by which IVIG suppresses
harmful inflammation has not been definitively established.
Testing for various known antibodies working against nervous system
tissue can be considered in those patients with epilepsy whose epilepsy has no
identifiable cause and is poorly controlled. Research has shown that, when
appropriate, treating with a trial of immunotherapy as discussed above has been
effective.
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