IVIG is a blood product administered intravenously which may be used in the treatment of Lennox-Gastaut Syndrome and other forms of refractory epilepsy. There is emerging clinical evidence that IVIG may be of value in several refractory seizure conditions. (read more)
Corticosteroids (predominantly prednisolone and hydrocortisone) and adrenocorticotropic hormone (ACTH) have been used in the treatment of the epilepsies for over 50 years. ACTH continues to be used as the first line treatment choice for Infantile Spasms (IS). It is generally accepted that oral corticosteroids or ACTH will reduce or stop IS and normalise EEG findings in between 50% and 75% of patients within a week or two of starting treatment. However, controversy exists regarding the relation between the duration of spasms prior to diagnosis and response to treatment in terms of both the short and long term (specifically developmental and cognitive) outcome.
Cannabidiol (CBD) is a compound found in cannabis that may have potential therapeutic use for individuals living with Lennox-Gastaut Syndrome. The compound is said to quiet chemical and electrical activity in the brain without the drawback of effects from cannabis that THC typically includes. (read more)
INTRAVENOUS IMMUNOGLOBULIN (IVIG)
IVIG (intravenous immunoglobulin) is a blood product administered intravenously which may be used in the treatment of Lennox-Gastaut Syndrome and other forms of refractory epilepsy. IVIG comes from human plasma (the portion of the blood where the immune globulins and other blood proteins are contained (1) and is formed by taking antibodies
from thousands of blood donors. The plasma from all of these individuals is then pooled together and chemically treated to remove any other blood proteins or blood-borne pathogens.(2)
IVIG is given intravenously over a span of approximately 3-6 hours. Side effects of IVIG can include fever, rash, headache, fatigue and nausea (3). Most reactions occur during the infusion but some patients can develop side effects within the first few days. It is believed that since the side effects of IVIG are mild, this treatment should be available to patients who have been treated unsuccessfully even with new anti-epileptic drugs (4).
In 1977, IVIG was first reported to be effective in improving seizure frequency and behavior (5). Since then, several other clinical trials have been published, reporting improvement in seizures. For example, in one trial, 16 children with Lennox-Gastaut Syndrome were treated with IVIG and a significant improvement was seen in 8 of them (6). In
a separate trial in 1990, ten patients aged 4-14 years were given IVIG. Results showed that intravenous immunoglobulin had an immediate and pronounced effect on break-through seizure activity and a simultaneous neurophysiologic effect in 20% of patients with Lennox-Gastaut Syndrome (7).
There is emerging clinical evidence that IVIG may be of value in several refractory seizure conditions. The details regarding which patients and at what point of the illness it should be used need to be investigated further (8).
1 BDI Pharma, Inc. 2010. BDI Pharma, Inc. 27 April 2010
2 Towson, MD.Immune Deficiency Foundation.IDF Patient and Family Handbook: For Primary Immunodeficiency Disease, 4th Edition. 2007.
3 Duhem C, Dicato MA, Ries F.Clin Exp Immunol. 1994 July; 97(Suppl 1): 79–83. Side Effects of intravenous immune globins.
4 Cavazzuti GB Neurological Sciences 2003 October; 24(4) s244-s245. Infantile Encephalopathies.
5 Pechadre JC, et al. The treatment of epileptic encephalopathies with gamma globulin in children. Electroencephalogr Neurophysiol Clin. 1977 Oct-Dec;7(4):443-7.
6 Ariizumi M, Baba K, Shiihara H,Lancet 1983;2:162-163. High-dose gammaglobulin for intractable childhood epilepsy. Ariizumi M, Baba K, Shiihara H,
7 Illum N, Taudorf K, et al. Neuropediatrics. 1990 May;21(2):87-90. Intravenous immunoglobulin: a single-blind trial in children with Lennox-Gastaut syndrome.
8 Epilepsy.com, 2010. 26 April 2010