[Malignant epilepsy in children: therapy with high doses of intravenous immunoglobulin]

Abstract

22 children with intractable childhood epilepsy (ICE) showing no response to conventional drugs of hormone (ACTH, Synacten) therapy were administered i.v. immunoglobulin (ENDOBULIN immuno) at a dosage of 400 mg/kg on the first and 15th day and subsequently every 3 weeks for 6 months. 12/22 patients showed IgG2 subclass deficiency. A significant reduction in attacks, or even absence of attacks was observed in 13/22 children after 6 months of i.v. immunoglobulin therapy. Most of this children showed IgG2 subclass deficiency. The reduction of attacks after i.v. immunoglobulin therapy correlated with the improvement or normalization of the EEG finding. As for the psychomotor development, no major changes were noticed with respect to the condition prior to the therapy, but in children with IgG2 deficiency, there is no further psychomotor deterioration. 6 months after the last i.v. immunoglobulin dose positive therapeutic effect remained in 5/22 children, with 3 children the therapy was repeated because of recidive attacks and worse EEG findings, and proved effective. Light worsening of the EEG findings was found in 3/22 children, 2/22 dropped out, 1/22 child died of intercurrent infection, and in girl the attacks ceased entirely 4 months after the last i.v. immunoglobulin dose. With other children the condition remained unchanged. According to the authors opinion, i.v. immunoglobulin has its own place in ICE treatment, and it is evident in all cases where the classical antiepileptic and/or hormone therapy was unsuccessful, especially in children with IgG2 subclass deficiency, that is, in all the epilepsy cases where a great number of attacks is imperilling the psychomotor development in children, independently of type.