Department of Neurology and Rehabilitation, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland.
Epilepsy Res. 2013 Jan;103(1):54-61. doi: 10.1016/j.eplepsyres.2012.06.002. Epub 2012 Jun 29.
Dysfunction of immunoglobulins (Igs) has been detected in association with antiepileptic drugs (AEDs) and in newly diagnosed epilepsy patients. The aim of this study was to evaluate the effect of clinical features and the current or past use of AEDs on serum Ig concentrations in a well-examined group of patients with refractory epilepsy.
Using a nephelometric method, concentrations of IgA, IgG and IgM were analyzed in the sera of 257 patients with refractory epilepsy, 15 patients with controlled epilepsy and 584 healthy control subjects.
A low IgA concentration was found in 8.8% of the patients with epilepsy compared with 1.9% of the control subjects. High concentrations of IgA were associated with temporal lobe epilepsy (TLE) compared with other epilepsy types (p=0.042). The high concentrations of IgA (p=0.042), low concentrations of IgG (p=0.002), and high concentrations of IgG (p=0.008) were also associated with autoimmune diseases. The use of lamotrigine, nitrazepam, oxcarbazepine, topiramate and valproic acid was associated with alterations in Ig concentrations. Current use of topiramate was associated with high serum IgG and IgM concentrations (OR 10.39; 95% CI: 3.08-35.04 and OR 7.02; 95% CI: 1.25-39.55, respectively).
The finding of high serum IgA concentration in patients with TLE strengthens the previously found association of immunological activity in the epileptic temporal lobe rather than other brain regions. The newly observed immunological effects of topiramate are important to proper AED choice in patients with refractory epilepsy.
免疫球蛋白（Igs）功能障碍已在抗癫痫药物（AEDs）和新诊断的癫痫患者中被检测到。本研究的目的是评估临床特征以及当前或过去使用 AEDs 对一组难治性癫痫患者血清 Ig 浓度的影响。
使用散射比浊法分析了 257 例难治性癫痫患者、15 例癫痫控制患者和 584 例健康对照者血清中 IgA、IgG 和 IgM 的浓度。
与对照组相比，癫痫患者中有 8.8%的人存在 IgA 浓度低，而有 1.9%的对照组存在 IgA 浓度高。与其他癫痫类型相比，颞叶癫痫（TLE）患者的 IgA 浓度较高（p=0.042）。与其他癫痫类型相比，高浓度的 IgA（p=0.042）、低浓度的 IgG（p=0.002）和高浓度的 IgG（p=0.008）与自身免疫性疾病有关。使用拉莫三嗪、硝基安定、奥卡西平、托吡酯和丙戊酸与 Ig 浓度改变有关。目前使用托吡酯与高血清 IgG 和 IgM 浓度相关（OR 10.39；95%CI：3.08-35.04 和 OR 7.02；95%CI：1.25-39.55）。
在 TLE 患者中发现高血清 IgA 浓度，进一步证实了先前发现的癫痫颞叶而非其他脑区的免疫活性的关联。托吡酯新观察到的免疫作用对于选择合适的难治性癫痫患者的 AED 非常重要。
