Serum antibodies in epilepsy and seizure-associated disorders
Serum antibodies in epilepsy and seizure-associated disorders
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DOI：
10.1212/01.wnl.0000187129.66353.13
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发表时间：
2005-12-13
期刊：
影响因子：
9.9
通讯作者：
Lang, B
中科院分区：
文献类型：
--
作者：
McKnight, K;Jiang, Y;Lang, B
目的：探讨癫痫和癫痫相关疾病患者血清中是否存在抗离子通道和其他神经抗原的自身抗体。研究方法：从139名患者中获得血清，其中包括26名预先存在的自身免疫性疾病，46名怀疑自身免疫性疾病，67名耐药癫痫患者。检测血清中电压门控钾（VGKC）和钙（VGCC）通道、谷氨酸脱羧酶（GAD）、神经节苷脂、谷氨酸受体3型、心磷脂、DNA和核抗原的抗体;将结果与健康和疾病对照的大队列结果进行比较。结果：139例癫痫患者中有16例（11%）VGKC抗体滴度升高（> 100 pM），而对照组仅1例（0.5%）。8例VGKC阳性患者出现急性/亚急性疾病，其中5例VGKC抗体最高; 3例患者自发改善，另外5例患者对免疫调节治疗反应良好。其他VGKC阳性患者的病程较长（> 6年），抗体水平中等;免疫疗法尚未在该组中进行测试。在另外3例（2.1%）长期耐药癫痫患者中发现极高水平的GAD抗体（> 1，000 U）。结论：电压门控钾通道和谷氨酸脱羧酶自身抗体的存在表明，免疫系统可能有助于某些形式的癫痫或癫痫相关疾病。需要进一步的研究来确定抗体是否是致病的。
Objective: To investigate whether autoantibodies to ion channels and other neural antigens are present in the sera of patients with epilepsy and seizure-related diseases. Methods: Sera were obtained from 139 patients, including 26 with preexisting autoimmune disease, 46 in whom an autoimmune basis was suspected, and 67 with drug-resistant epilepsy. The sera were assayed for antibodies to voltage-gated potassium (VGKC) and calcium (VGCC) channels, glutamic acid decarboxylase ( GAD), gangliosides, glutamate receptor type 3, cardiolipins, DNA, and nuclear antigens; the results were compared with results from a large cohort of healthy and disease controls. Results: Increased titers of VGKC antibodies ( > 100 pM) were detected in 16 of 139 (11%) patients with seizures but only 1 control (0.5%). Eight VGKC-positive patients presented with an acute/subacute illness, and 5 of these had the highest VGKC antibodies; 3 patients improved spontaneously, another 5 patients responded well to immunomodulatory therapy. The other VGKC-positive patients had longer disease duration ( > 6 years) and intermediate levels of antibodies; immunotherapies have not been tested in this group. Very high levels of GAD antibodies ( > 1,000 U) were found in an additional 3 patients (2.1%) with long-standing drug-resistant epilepsy. Conclusions: The presence of autoantibodies to voltage-gated potassium channels and glutamic acid decarboxylase suggests that the immune system may contribute to certain forms of epilepsy or seizure-associated disorders. Further studies are needed to determine whether the antibodies are pathogenic.