Department of Neurology and Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany.
Eur J Neurol. 2014 Mar;21(3):395-401. doi: 10.1111/ene.12261. Epub 2013 Oct 1.
The influence of the immune system on seizures and epileptogenesis has been increasingly considered, in particular the role of autoantibodies. In this study, we aimed to determine the frequency of intrathecal antibody synthesis in the cerebrospinal fluid (CSF) compartment of patients with epilepsy.
In a retrospective cohort study trial in a university hospital neurology department, 164 well-characterized patients with different etiologies of seizures and epilepsies, and 77 control patients were included.
CSF-specific immunoglobulin (IgG, IgM and IgA) synthesis was significantly (P < 0.0001) more frequent in patients with epilepsy (34.1%) compared with age- and sex-matched controls (2.6%). The highest incidence of intrathecal Ig synthesis was detected in patients with encephalitis-related acute symptomatic seizures (86.7%), but also in patients with focal epilepsy so far classified cryptogenic (45.2%). Antibody synthesis was not related to the number of CSF white blood cells.
Humoral immune activation in the CSF compartment was detected in one-third of patients with epilepsy, besides acute symptomatic seizures particularly frequent in cryptogenic epilepsy--an etiology so far defined as not having a detectable cause. Systematic prospective clinical and experimental trials are required to identify antigenic targets and select appropriate patients for which immunotherapy might offer new causal therapeutic options.
免疫系统对癫痫发作和癫痫形成的影响已越来越受到关注，特别是自身抗体的作用。本研究旨在确定癫痫患者脑脊液（CSF）中鞘内抗体合成的频率。
在一家大学医院神经内科进行的回顾性队列研究中，纳入了 164 例具有不同病因的癫痫发作和癫痫患者以及 77 例对照患者。
与年龄和性别匹配的对照组（2.6%）相比，癫痫患者（34.1%）CSF 特异性免疫球蛋白（IgG、IgM 和 IgA）合成显著更为频繁（P<0.0001）。在脑炎相关的急性症状性癫痫发作患者（86.7%）中，检测到最高的鞘内 Ig 合成发生率，但在目前归类为隐源性的局灶性癫痫患者中也存在（45.2%）。抗体合成与 CSF 白细胞数量无关。
除急性症状性癫痫发作外，三分之一的癫痫患者的脑脊液中存在体液免疫激活，特别是在目前被定义为无明显病因的隐源性癫痫中更为常见。需要系统的前瞻性临床和实验研究来确定抗原靶点，并选择适当的免疫治疗患者，免疫治疗可能为新的病因治疗提供新的选择。
