Tocilizumab in pediatric refractory status epilepticus and acute epilepsy: Experience in two patients

J Neuroimmunol. 2020 Mar 15:340:577142. doi: 10.1016/j.jneuroim.2019.577142. Epub 2020 Jan 3.

Abstract

There is growing evidence for inflammation as a cause and/or consequence of seizures in epilepsy as certain inflammatory biomarkers are elevated. Interleukin (IL)-6, with pro-inflammatory and epileptogenic effects, can perpetuate seizures. Clinical and experimental data support its involvement in acute refractory situations, with some cases responding to treatment with tocilizumab, a humanized monoclonal antibody against the IL-6 receptor. We describe 2 pediatric cases of refractory epilepsy with an abrupt debut responding to tocilizumab. Advances in the knowledge of inflammatory biomarkers involved in epilepsy and the targeted treatment could have important benefits, especially in cases that are refractory to usual treatments.

Keywords: Epilepsy; FIRES/NORSE; Interleukin (IL)-6; Neuroinflammation; RELN; Tocilizumab.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Child
  • Drug Resistant Epilepsy / blood
  • Drug Resistant Epilepsy / drug therapy*
  • Drug Resistant Epilepsy / immunology
  • Female
  • Humans
  • Inflammation / complications
  • Interleukin-6 / blood
  • Male
  • Receptors, Interleukin-6 / antagonists & inhibitors
  • Reelin Protein
  • Status Epilepticus / blood
  • Status Epilepticus / drug therapy*
  • Status Epilepticus / immunology

Substances

  • Antibodies, Monoclonal, Humanized
  • IL6 protein, human
  • IL6R protein, human
  • Interleukin-6
  • Receptors, Interleukin-6
  • Reelin Protein
  • RELN protein, human
  • tocilizumab