Inmunoterapia en epilepsia refractaria / Immunotherapy in refractory epilepsy

RESUMEN

Se revisa el uso de inmunoglobulina y hormona adrenocorticotrópica en epilepsia refractaria, como terapias alternas para el manejo de estos pacientes. Esta aplicación tiene soporte fisiopatológico, ya que se conocen claramente los fenómenos inflamatorios asociados a la epilepsia, que bloquean los mecanismos inhibitorios y facilitan la excitación neuronal. Existen descripciones claras del uso exitoso de la inmunoglobulina en casos de encefalitis de Rasmüssen, síndromes de Lennox-Gastaut, Landau-Kleffner y epilepsia de focos variables, también se ha utilizado como tratamiento de rescate en síndrome de West. El tratamiento de elección en Estados Unidos; no existe diferencia estadística en cuanto a su efectividad en este síndrome comparada con vigabatrin.

ABSTRACT

This paper reviews the use of immunoglobulin and adrenocorticotropic hormone in the management of refractory epilepsy, as alternative therapies for these patients. This application is clearly supported by physiopathology, the inflammatory phenomena associated to epilepsyare clearly known, they act by blocking inhibitory mechanisms and allowing for neuronal excitation. There are comprehensive descriptions about the successful use of immunoglobulin in disorders such as Rasmüssen’s encephalitis, Lennox-Gastaut syndrome, Landau-Kleffner syndrome and epilepsy with variable foci, and it has been also used as rescue treatment in West syndrome. It is the treatment of choice in the United States, and there is no statistical difference in effectiveness in this syndrome when compared with vigabatrin. In order to use these treatments, intercurrent infections should be ruled out and it is necessary to monitor closely its use to prevent complications.