The Effects of IVIG on Seizure Frequency and EEG Activity in Refractory Childhood Epilepsy
Abstract number :
3.233
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2205155
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Aya Ebdalla, BS, BA – University of Calgary; Juan Appendino, MD – University of Calgary; Alice Ho, MD – University of Calgary; Julia Jacobs-LeVan, MD – University of Calgary; Morris Scantlebury, MD – University of Calgary
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 and effects on electroencephalograms (EEG) exists._x000D_
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, antiseizure medications (ASM) treatment history, adverse effects, and the seizure frequency score at baseline (the score at the last visit prior to starting IVIG), 3 months post-, and 1-year post-IVIG therapy. EEGs completed up to 18 months post-IVIG were selected from the Natus EEG database and analyzed for the following parameters: background activity, sleep activity, and paroxysmal events.
Results: Seventy-four patients aged 2 to 17 years old (mean ± SEM, 12.3 ± 4.2) were identified as treated with IVIG for medically refractory epilepsy. There was no difference in the number of ASM prior to (4.2 ± 2.2) or during IVIG therapy (4.6 ± 2.3, p=0.28). The most common epilepsy etiologies were genetic (44.6%, n = 33), structural (32.4%, n = 21), and unknown (23.0%, n=17). There was no clear relationship between IVIG efficacy and etiology. Sex specific effects were also not observed. However, seizure frequency was significantly reduced by at least 25% at 3 months post-IVIG (p=0.02) and at 1-year post-IVIG (p=0.006) (Figure 1). Further, 31.1% (n = 23) experienced a seizure reduction by >50%. A total of 22 patients (29.8%) exhibited improvement in EEG background, sleep activity or paroxysmal within 18 months post-IVIG. Improvement of EEG measures correlated with a clinical seizure reduction of 50% or more (p=0.02) (Figure 2).
Conclusions: The long-term anti-epileptic effects of IVIG may be explained by impaired spreading of electrical activity thereby preventing clinical seizures, as demonstrated by an association between seizure frequency reduction and improved EEG parameters.
Funding: Alberta Children's Hospital Research Institute (ACHRI)
Clinical Epilepsy