2021 Volume 53 Issue 1 Pages 33-38
Objective: Many cases of epilepsy after encephalitis/encephalopathy are intractable, but there are reports that methylprednisolone pulse therapy (pulse therapy) is effective for seizure control. We aimed to evaluate the relation between cerebrospinal fluid (CSF) levels of cytokines before pulse therapy and efficacy of the therapy, to reveal predictive factors for better seizure outcome. Methods: Among patients with epilepsy after encephalitis/encephalopathy treated by pulse therapy in Shizuoka Institute of Epilepsy and Neurological Disorders, we evaluated 15 patients in whom CSF cytokine and chemokine levels were measured by BioPlex before pulse therapy. The regimen of pulse therapy was one course of methylprednisolone (30mg/kg/day for 3 days) per month. We classified patients with seizure reduction rate of 50% or more into effective group, after three MPs. We compared CSF cytokine levels between the effective group and ineffective group. Results: Five of 15 patients (33.3%) were in the effective group. The ineffective group included eight patients with slight decrease of seizure frequency or improvement of seizure characteristics, and seven patients with behavioral and cognitive improvements such as vocabulary. None of the patients treated with pulse therapy showed increased seizure frequency or cognitive and behavioral deterioration. Age at MP and numbers of MPs were not significantly different between effective group and ineffective group. CSF levels of CCL4 in effective group was lower than ineffective group and disease controls, and CSF levels of IL-9, IL-12, and CCL3 in ineffective group were higher than effective group and disease controls. Conclusions: Our study in epilepsy after encephalitis/encephalopathy may suggest effectiveness of pulse therapy in patients with lower levels of CCL4 in CSF, and ineffectiveness in patients with higher levels of IL-9, IL-12, and CCL3.
