Autoimmune EpilepsyClinical Characteristics and Response to Immunotherapy
Arch Neurol. Published online March 26, 2012. doi:10.1001/archneurol.2011.2985
Objective To describe clinical characteristics and immunotherapy responses in patients with autoimmune epilepsy.
Design Observational, retrospective case series.
Setting Mayo Clinic Health System.
Patients Thirty-two patients with an exclusive (n = 11) or predominant (n = 21) seizure presentation in whom an autoimmune etiology was suspected (on the basis of neural autoantibody [91%], inflammatory cerebrospinal fluid [31%], or magnetic resonance imaging suggesting inflammation [63%]) were studied. All had partial seizures: 81% had failed treatment with 2 or more antiepileptic drugs and had daily seizures and 38% had seizure semiologies that were multifocal or changed with time. Head magnetic resonance imaging was normal in 15 (47%) at onset.
Electroencephalogram abnormalities included interictal epileptiform discharges in 20; electrographic seizures in 15; and focal slowing in 13. Neural autoantibodies included voltage-gated potassium channel complex in 56% (leucine-rich, glioma-inactivated 1 specific, 14; contactin-associated proteinlike 2 specific, 1); glutamic acid decarboxylase 65 in 22%; collapsin response-mediator protein 5 in 6%; and Ma2, N-methyl-D-aspartate receptor, and ganglionic acetylcholine receptor in 1 patient each.
Intervention Immunotherapy with intravenous methylprednisolone; intravenous immune globulin; and combinations of intravenous methylprednisolone, intravenous immune globulin, plasmapheresis, or cyclophosphamide.
Main Outcome Measure Seizure frequency.
Results After a median interval of 17 months (range, 3-72 months), 22 of 27 (81%) reported improvement postimmunotherapy; 18 were seizure free. The median time from seizure onset to initiating immunotherapy was 4 months for responders and 22 months for nonresponders (P < .05). All voltage-gated potassium channel complex antibody–positive patients reported initial or lasting benefit (P < .05). One voltage-gated potassium channel complex antibody–positive patient was seizure free after thyroid cancer resection; another responded to antiepileptic drug change alone.
Conclusion When clinical and serological clues suggest an autoimmune basis for medically intractable epilepsy, early-initiated immunotherapy may improve seizure outcome.
Author Affiliations: Departments of Laboratory Medicine and Pathology (Drs Quek, McKeon, Lennon, Klein, and Pittock), Neurology (Drs Britton, McKeon, So, Lennon, Shin, Klein, Lagerlund, Cascino, Worrell, Wirrell, Nickels, Aksamit, and Pittock), Immunology (Dr Lennon), and Radiology (Drs Watson and Kotsenas), Mayo Clinic, College of Medicine, Rochester, Minnesota; and Department of Neurology, Mayo Clinic, College of Medicine, Scottsdale, Arizona (Dr Noe).
Saturday, March 31, 2012
Nearly two-thirds of American children with autism have been bullied at some point in their lives, and these kids are bullied three times more often than their siblings without autism, a new survey finds.
Bullying occurs in every grade but is worst in grades five through eight, with 42 percent to 49 percent of autistic children in those grades bullied, according to the survey of nearly 1,200 parents of autistic children ages 6 to 15.
The Interactive Autism Network (IAN), a project of the Kennedy Krieger Institute, conducted the survey.
"These survey results show the urgent need to increase awareness, influence school policies and provide families and children with effective strategies for dealing with bullying," Paul Law, director of the IAN Project, said in an institute news release.
Children with autism, a developmental disorder, usually have delayed language development and difficulty with social interaction.
"Children with [autism] are already vulnerable. To experience teasing, taunts, ostracism or other forms of spite may make a child who was already struggling to cope become completely unable to function," Law said. "The issue is complex and we plan to carefully analyze the data and publish peer-reviewed findings that will serve to advance policy and care for individuals with [autism]."
Overall, 63 percent of kids with an autism spectrum disorder have been bullied at some time, the survey found.
Children with autism in public schools are bullied nearly 50 percent more often than those in private schools or special-education schools, the researchers found.
Types of bullying experienced by autistic children include: being teased, picked on or made fun of (73 percent); being ignored or left out of things on purpose (51 percent); being called bad names (47 percent); and being pushed, shoved, hit, slapped or kicked (30 percent).
Bullying is experienced by 57 percent of children with autism who want to interact with others but have difficulty making friends, compared with 25 percent of those who prefer to play alone and 34 percent of those who will play with others only if approached.
Fifty-two percent of the parents said their child had been taunted by other children in order to trigger a meltdown or aggressive outburst.
Kids with Asperger's syndrome, a high-functioning type of autism, were nearly twice as likely as children with another autism disorder to be bullied, perhaps because of different school placements, the researchers said.
Sleep apnea, a condition that causes sleepers to stop breathing and gasp for air, may be linked to depression, according to a new study. Men with sleep apnea are twice as likely to be depressed and the emotional impact for women is even greater. Female sleep apnea sufferers are five times as likely to show signs of depression compared to normal sleepers, researchers reported.