Evaluation of response rate and prognostic factors in children with refractory status epilepsy treated with intravenous immunoglobulin

Abstract

Status Epilepsies are one of the most common emergencies in neuroscience that can endanger the patient's life. The main predictors of disease outcome are the patient's age, the cause of the epilepsy and the duration of that. Immune-based therapies, such as intravenous immunoglobulin injections, are used when conventional therapies, such as anticonvulsants, do not work well or there is a high probability of an autoimmune process. Objective: The aim of this study was to evaluate the effect of intravenous immunoglobulin and the findings of predictive indicators in children with refractory status epilepsy. Materials & Methods: In this study, we collected the records of all pediatric patients who referred to Tabriz Children's Hospital with refractory status epilepsy and received intravenous immunoglobulin treatment, during one year. After reviewing the inclusion and exclusion criteria, we entered the data of 30 patients into the study and continued this information collecting until the follow-up of the sixth month after receiving treatment. The obtained information was statistically analyzed and interpreted. Results: 20 boys and 10 girls with a mean age of 2.371 ± 2.371 were studied. The number of seizures varied from once a week to 8 times a day. The number of anti-epileptic drugs prescribed for patients was 4 drugs that did not decrease after treatment and even at follow-up. Regarding the cause of epilepsy, 14 patients were of unknown cause, 7 were genetic causes, 5 were structural causes, 3 were hypoxic encephalopathies and one was due to head trauma complications. There is a significant relationship between the causes of seizures and their types. But due to the large number of unknown causes, it could not be concluded. Imaging results from 14 patients show evidence of a variety of disorders that are significantly associated with the response to immunoglobulin treatment (P = 0.038) and the incidence of disease complications. (P = 0.07) 76.7% of patients developed post-disease complications such as mental retardation and attention-hyperactivity disorder. Antiphospholipid antibodies, if present, indicate a higher risk of complications.