Efficacy of intravenous immunoglobulin in children with drug-resistant epilepsy

Purpose Inflammation may contribute to drug-resistant epilepsy (DRE) in children and immunomodulatory therapies, including intravenous immunoglobulin (IVIG), have been described to reduce seizure burden. This retrospective study assesses the effect of IVIG on seizures in a tertiary epilepsy center. Methods We performed a retrospective chart review of children with DRE using our Pediatric Epilepsy Outcome-Informatics database, which contains standardized information on 3,650 pediatric epilepsy patients collected at the point of care. Inclusion criteria were refractory seizures, regular follow-up and treatment with IVIG for at least 1 year. Patients with autoimmune encephalitis were excluded from the analysis. Sex, etiology, epilepsy syndromes, seizure types, antiseizure medications (ASM), adverse effects, and seizure frequency scores prior, 3 months post-, and 1-year post-IVIG were collected and statistically compared. Results Sixty patients aged 2–18 years (mean ± SD, 11.8 ± 4.13) were included. Patients exhibited focal (38.3%, n = 23), generalized (36.7% ( n = 22), or both seizure types (25.0%, n = 15). Overall, 36.7% ( n = 22) demonstrated at least 50% seizure frequency reduction within 1 year of IVIG use, and 36.4% ( n = 8) achieved seizure freedom. A significant reduction of seizures in individual patients was only observed in those with generalized seizures ( p = 0.019). These findings could not be explained by changes in other ASMs. Conclusion Long-term use of IVIG in pediatric patients can be an effective treatment for refractory seizures, even if exact mechanisms remain unclear.