Treatment of immune-mediated temporal lobe epilepsy with GAD antibodies

AbstractPurposeTemporal lobe epilepsy with antibodies (abs) against the glutamic acid decarboxylase 65 isoform (GAD-TLE) is known as an immune-mediated neurological syndrome. Here we evaluate the therapy response to various immunotherapies and epilepsy surgery in this syndrome.MethodAll patients with GAD-TLE and follow-up data and stored serum and CSF samples, identified and treated at the Bonn centre from 2002 to 2010, were studied retrospectively. Seizure freedom for ≥1 year and reduction of ≥50%, i.e. therapy response, were assessed. GAD-ab titres and neuropsychological performances were documented prior and after individual interventions.ResultsThirteen patients with GAD-TLE were identified with the following seizure responses: corticosteroids (5 responders out of 11 treated patients); i.v. immunoglobulins (1/5), apheresis therapy (1/8); and natalizumab (1/1), selective amygdala-hippocampectomy (2/3). None of the patients achieved sustained seizure freedom apart from one patient. This patient was on antiepileptic drug treatment after discontinuation of immunotherapy.ConclusionThe seizure response to immunotherapies in patients with GAD-TLE was poor. Corticosteroids were the most effective regarding seizure response. Especially the poor effects of apheresis therapies support the idea that GAD-abs are not directly pathogenic. None of three patients was seizure-free after temporal lobe surgery suggesting that GAD-TLE patients respond worse than others to this type of intervention. Our results reflect the chronic course of the disease with low likelihood for patients with GAD-TLE to attain long-term seizure freedom

Study of Counting Characteristics of Porous Radiation Detectors

This paper presents the development of a new technology of registration of ionizing radiation and a new type of detectors - single-cathode multiwire porous detector with neither a gaseous nor semiconductor, but a porous dielectric substance, e.g., CsI, being used as working medium. It is shown that the performance of the multiwire porous detector is stable, ensuring highly efficient detection of both heavily ionizing particles and soft X-rays with a spatial resolution better than $\pm 60\mu m$. The continuous stable performance opens up new perspectives for using porous detectors in research as well as medicine. The obtained data are basic for the development of the theory of the phenomenon of electrons' drift and multiplication in porous dielectrics under the action of a strong external electric field.Comment: 43