Epilepsilerde İmmunmodülatuar Tedavi Seçenekleri
Özet
Otoimmun epilepsilerin tedavisi için randomize kontrollü çalışmalar bulunmamaktadır. Anti nöbet ilaçların yanı sıra tetikleyici etmene yönelik cerrahi işlem ve immunsüpresif - immunmodülatuar ilaçlar tedavinin mihenk taşıdır. Tedavi genellikle vaka serilerinin sonuçları ve uzman görüşüne dayanmaktadır. Otoimmun epilepsilerin erken dönemde tanınması ve erken dönemde tedavi verilmesi engelliği azaltmada en önemli basamaktır. İmmunoterapi, kanser gibi immun tetikleyicilerin
ortadan kaldırılması ve antinöbet ilaç
(ANİ) kullanımı tedavinin üç ana temel öğesidir.
There are no randomised controlled trials for the treatment of autoimmune epilepsies. In addition to antiepileptic drugs, the mainstay of treatment is surgery to remove the triggering factor and immunosuppressive - immunomodulatory drugs. Treatment is generally based on the results of case series and expert opinion. Early recognition and treatment of autoimmune epilepsies is the most important step in reducing disability. Immunotherapy, elimination of the cancer, and antiepileptic drugs are the three main methods of treatment.
Referanslar
Toledano M, Britton JW, McKeon A, Shin C, Lennon VA, Quek AM, et al. Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy. Neurology. 2014;82(18):1578-86.
Abboud H, Probasco JC, Irani S, Ances B, Benavides DR, Bradshaw M, et al. Autoimmune encephalitis: proposed best practice recommendations for diagnosis and acute management. J Neurol Neurosurg Psychiatry. 2021;92(7):757-68.
Sechi E, Flanagan EP. Antibody-Mediated Autoimmune Diseases of the CNS: Challenges and Approaches to Diagnosis and Management. Front Neurol. 2021;12:673339.
Jiang Y, Tian X, Gu Y, Li F, Wang X. Application of Plasma Exchange in Steroid-Responsive Encephalopathy. Front Immunol. 2019;10:324.
Macher S, Zimprich F, De Simoni D, Höftberger R, Rommer PS. Management of Autoimmune Encephalitis: An Observational Monocentric Study of 38 Patients. Front Immunol. 2018;9:2708.
Dubey D, Singh J, Britton JW, Pittock SJ, Flanagan EP, Lennon VA, et al. Predictive models in the diagnosis and treatment of autoimmune epilepsy. Epilepsia. 2017;58(7):1181-9.
Dubey D, Kothapalli N, McKeon A, Flanagan EP, Lennon VA, Klein CJ, et al. Predictors of neural-specific autoantibodies and immunotherapy response in patients with cognitive dysfunction. J Neuroimmunol. 2018;323:62-72.
Hachiya Y, Uruha A, Kasai-Yoshida E, Shimoda K, Satoh-Shirai I, Kumada S, et al. Rituximab ameliorates anti-N-methyl-D-aspartate receptor encephalitis by removal of short-lived plasmablasts. J Neuroimmunol. 2013;265(1-2):128-30.
Mahévas M, Michel M, Weill JC, Reynaud CA. Long-lived plasma cells in autoimmunity: lessons from B-cell depleting therapy. Front Immunol. 2013;4:494.
Sorensen PS, Blinkenberg M. The potential role for ocrelizumab in the treatment of multiple sclerosis: current evidence and future prospects. Ther Adv Neurol Disord. 2016;9(1):44-52.
Cree BAC, Bennett JL, Kim HJ, Weinshenker BG, Pittock SJ, Wingerchuk DM, et al. Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): a double-blind, randomised placebo-controlled phase 2/3 trial. Lancet. 2019;394(10206):1352-63.
The ExTINGUISH Trial of Inebilizumab in NMDAR Encephalitis (ExTINGUISH). Accessed 4 May 2021. 2020;https:// clini caltr ials. gov/ ct2/ show/NCT04 372615.
Tanaka T, Narazaki M, Kishimoto T. IL-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol. 2014;6(10):a016295.
Cassese G, Arce S, Hauser AE, Lehnert K, Moewes B, Mostarac M, et al. Plasma cell survival is mediated by synergistic effects of cytokines and adhesion-dependent signals. J Immunol. 2003;171(4):1684-90.
Jourdan M, Cren M, Robert N, Bolloré K, Fest T, Duperray C, et al. IL-6 supports the generation of human long-lived plasma cells in combination with either APRIL or stromal cell-soluble factors. Leukemia. 2014;28(8):1647-56.
Lee WJ, Lee ST, Moon J, Sunwoo JS, Byun JI, Lim JA, et al. Tocilizumab in Autoimmune Encephalitis Refractory to Rituximab: An Institutional Cohort Study. Neurotherapeutics. 2016;13(4):824-32.
Vezzani A, Moneta D, Conti M, Richichi C, Ravizza T, De Luigi A, et al. Powerful anticonvulsant action of IL-1 receptor antagonist on intracerebral injection and astrocytic overexpression in mice. Proc Natl Acad Sci U S A. 2000;97(21):11534-9.
Noe FM, Polascheck N, Frigerio F, Bankstahl M, Ravizza T, Marchini S, et al. Pharmacological blockade of IL-1β/IL-1 receptor type 1 axis during epileptogenesis provides neuroprotection in two rat models of temporal lobe epilepsy. Neurobiol Dis. 2013;59:183-93.
Choi CH, Ma SH, Ma KK, Leung H, Mok VC. Super-refractory status epilepticus in autoimmune encephalitis treated with interleukin-1 receptor antagonist, anakinra. Epileptic Disord. 2021;23(3):500-5.
Costagliola G, Depietri G, Michev A, Riva A, Foiadelli T, Savasta S, et al. Targeting Inflammatory Mediators in Epilepsy: A Systematic Review of Its Molecular Basis and Clinical Applications. Front Neurol. 2022;13:741244.
Pellegrin S, Baldeweg T, Pujar S, D'Arco F, Cantalupo G, Varadkar S, Cross JH. Immunomodulation With Azathioprine Therapy in Rasmussen Syndrome: A Multimodal Evaluation. Neurology. 2021;96(2):e267-e79.
Hao XS, Wang JT, Chen C, Hao YP, Liang JM, Liu SY. Effectiveness of Mycophenolate Mofetil in the Treatment of Pediatric Anti-NMDAR Encephalitis: A Retrospective Analysis of 6 Cases. Front Neurol. 2020;11:584446.
Nosadini M, Mohammad SS, Toldo I, Sartori S, Dale RC. Mycophenolate mofetil, azathioprine and methotrexate usage in paediatric anti-NMDAR encephalitis: A systematic literature review. Eur J Paediatr Neurol. 2019;23(1):7-18.
Referanslar
Toledano M, Britton JW, McKeon A, Shin C, Lennon VA, Quek AM, et al. Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy. Neurology. 2014;82(18):1578-86.
Abboud H, Probasco JC, Irani S, Ances B, Benavides DR, Bradshaw M, et al. Autoimmune encephalitis: proposed best practice recommendations for diagnosis and acute management. J Neurol Neurosurg Psychiatry. 2021;92(7):757-68.
Sechi E, Flanagan EP. Antibody-Mediated Autoimmune Diseases of the CNS: Challenges and Approaches to Diagnosis and Management. Front Neurol. 2021;12:673339.
Jiang Y, Tian X, Gu Y, Li F, Wang X. Application of Plasma Exchange in Steroid-Responsive Encephalopathy. Front Immunol. 2019;10:324.
Macher S, Zimprich F, De Simoni D, Höftberger R, Rommer PS. Management of Autoimmune Encephalitis: An Observational Monocentric Study of 38 Patients. Front Immunol. 2018;9:2708.
Dubey D, Singh J, Britton JW, Pittock SJ, Flanagan EP, Lennon VA, et al. Predictive models in the diagnosis and treatment of autoimmune epilepsy. Epilepsia. 2017;58(7):1181-9.
Dubey D, Kothapalli N, McKeon A, Flanagan EP, Lennon VA, Klein CJ, et al. Predictors of neural-specific autoantibodies and immunotherapy response in patients with cognitive dysfunction. J Neuroimmunol. 2018;323:62-72.
Hachiya Y, Uruha A, Kasai-Yoshida E, Shimoda K, Satoh-Shirai I, Kumada S, et al. Rituximab ameliorates anti-N-methyl-D-aspartate receptor encephalitis by removal of short-lived plasmablasts. J Neuroimmunol. 2013;265(1-2):128-30.
Mahévas M, Michel M, Weill JC, Reynaud CA. Long-lived plasma cells in autoimmunity: lessons from B-cell depleting therapy. Front Immunol. 2013;4:494.
Sorensen PS, Blinkenberg M. The potential role for ocrelizumab in the treatment of multiple sclerosis: current evidence and future prospects. Ther Adv Neurol Disord. 2016;9(1):44-52.
Cree BAC, Bennett JL, Kim HJ, Weinshenker BG, Pittock SJ, Wingerchuk DM, et al. Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): a double-blind, randomised placebo-controlled phase 2/3 trial. Lancet. 2019;394(10206):1352-63.
The ExTINGUISH Trial of Inebilizumab in NMDAR Encephalitis (ExTINGUISH). Accessed 4 May 2021. 2020;https:// clini caltr ials. gov/ ct2/ show/NCT04 372615.
Tanaka T, Narazaki M, Kishimoto T. IL-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol. 2014;6(10):a016295.
Cassese G, Arce S, Hauser AE, Lehnert K, Moewes B, Mostarac M, et al. Plasma cell survival is mediated by synergistic effects of cytokines and adhesion-dependent signals. J Immunol. 2003;171(4):1684-90.
Jourdan M, Cren M, Robert N, Bolloré K, Fest T, Duperray C, et al. IL-6 supports the generation of human long-lived plasma cells in combination with either APRIL or stromal cell-soluble factors. Leukemia. 2014;28(8):1647-56.
Lee WJ, Lee ST, Moon J, Sunwoo JS, Byun JI, Lim JA, et al. Tocilizumab in Autoimmune Encephalitis Refractory to Rituximab: An Institutional Cohort Study. Neurotherapeutics. 2016;13(4):824-32.
Vezzani A, Moneta D, Conti M, Richichi C, Ravizza T, De Luigi A, et al. Powerful anticonvulsant action of IL-1 receptor antagonist on intracerebral injection and astrocytic overexpression in mice. Proc Natl Acad Sci U S A. 2000;97(21):11534-9.
Noe FM, Polascheck N, Frigerio F, Bankstahl M, Ravizza T, Marchini S, et al. Pharmacological blockade of IL-1β/IL-1 receptor type 1 axis during epileptogenesis provides neuroprotection in two rat models of temporal lobe epilepsy. Neurobiol Dis. 2013;59:183-93.
Choi CH, Ma SH, Ma KK, Leung H, Mok VC. Super-refractory status epilepticus in autoimmune encephalitis treated with interleukin-1 receptor antagonist, anakinra. Epileptic Disord. 2021;23(3):500-5.
Costagliola G, Depietri G, Michev A, Riva A, Foiadelli T, Savasta S, et al. Targeting Inflammatory Mediators in Epilepsy: A Systematic Review of Its Molecular Basis and Clinical Applications. Front Neurol. 2022;13:741244.
Pellegrin S, Baldeweg T, Pujar S, D'Arco F, Cantalupo G, Varadkar S, Cross JH. Immunomodulation With Azathioprine Therapy in Rasmussen Syndrome: A Multimodal Evaluation. Neurology. 2021;96(2):e267-e79.
Hao XS, Wang JT, Chen C, Hao YP, Liang JM, Liu SY. Effectiveness of Mycophenolate Mofetil in the Treatment of Pediatric Anti-NMDAR Encephalitis: A Retrospective Analysis of 6 Cases. Front Neurol. 2020;11:584446.
Nosadini M, Mohammad SS, Toldo I, Sartori S, Dale RC. Mycophenolate mofetil, azathioprine and methotrexate usage in paediatric anti-NMDAR encephalitis: A systematic literature review. Eur J Paediatr Neurol. 2019;23(1):7-18.
