Universität zu Köln

Malter, M. P., Frisch, C., Zeitler, H., Surges, R., Urbach, H., Helmstaedter, C., Elger, C. E. and Bien, C. G. (2015). Treatment of immune-mediated temporal lobe epilepsy with GAD antibodies. Seizure, 30. S. 57 - 64. LONDON: W B SAUNDERS CO LTD. ISSN 1532-2688

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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. (C) 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Malter, M. P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Frisch, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeitler, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Surges, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Urbach, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Helmstaedter, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Elger, C. E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bien, C. G. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-398314
DOI:	10.1016/j.seizure.2015.05.017
Journal or Publication Title:	Seizure
Volume:	30
Page Range:	S. 57 - 64
Date:	2015
Publisher:	W B SAUNDERS CO LTD
Place of Publication:	LONDON
ISSN:	1532-2688
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language GLUTAMIC-ACID DECARBOXYLASE; LIMBIC ENCEPHALITIS; CEREBELLAR-ATAXIA; POTASSIUM CHANNEL; PLASMA-EXCHANGE; CSF-FILTRATION; AUTOANTIBODIES; QUANTIFICATION; ONSET; CLUES Multiple languages Clinical Neurology; Neurosciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/39831