Abstracts

Rationale: Inflammation may contribute to ongoing medically refractory epilepsy in children and immunomodulatory therapies including intravenous immunoglobulin (IVIG) may have a therapeutic role. However, limited evidence supporting its efficacy exists.

Methods: A retrospective chart review of children with medically refractory epilepsy treated with at least one dose of IVIG within any neurology clinic at the Alberta Children’s Hospital. Patients were identified from our prospective Pediatric Epilepsy Outcome-Informatics database, which contains standardized data on 3650 pediatric patients with epilepsy collected at the point of care. Data collected for this study included sex, etiology, seizure types, antiepileptic drug (AED) treatment history, adverse effects, EEG results, and the seizure frequency score (Table 1) at baseline (the score at the last visit prior to starting IVIG), 3 months post-, and 1-year post-IVIG therapy. Patients diagnosed with an autoimmune disorder or who did not complete a 1-year course of treatment were excluded from the analysis.

Results: Seventy-four patients were identified in the database to have been treated with IVIG and 91.0 % (n= 67) met inclusion criteria. The age of the patients ranged from 2–17 years old (mean ± SEM, 11.5 ± 4.3) were identified as treated with IVIG for non-autoimmune intractable epilepsy of which six were excluded because IVIG was stopped prior to 1 year. Of the 67 patients included in the analysis 46.3% (n=31) were female. There was no difference in the number of AEDs prior to (4.6 ± 1.9, p=0.08) or during IVIG (5.1 ± 1.9, p=0.07) treatment. No difference in seizure reduction was observed at 3 months post treatment (p=0.106). However, at 1-year post treatment, IVIG was significantly associated with seizure frequency reduction (p=0.004), including both focal and generalized seizures (Figure 1). None of the treated patients had a normal EEG recorded nearest to the 1year time point. The most common epilepsy etiologies were genetic (50.7%, n=34), structural (25.4%, n=17) and unknown (23.9%, n=16). There was no clear relationship between etiology and effectiveness of IVIG. Sex specific effects were also not observed. Following treatment, 10.4% (n=7) of patients reported adverse effects including fatigue 1.5% (n=1), headache 4.5 % (n=3), hyperactivity 3.0% (n=2), and personality changes 1.5% (n=1).

Conclusions: Long-term use of IVIG appears well tolerated and provides efficacy to some pediatric patients with medically refractory epilepsy by reducing the frequency of generalized and focal seizures.

Funding: Please list any funding that was received in support of this abstract.: Alberta Children's Hospital Research Institute.