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Summary We evaluated mortality in relation to a panel of autoimmunity-related immunological serum markers in adult patients with epilepsy (PWE), seen in 1996–1997 at the Department of Neurology, Oulu University Hospital in Finland. Blood samples were drawn from 968 volunteers, and baseline measurements included serum immunoglobulins (IgG, IgA, and IgM), and the following antibodies: anticardiolipin, antinuclear, antimitochondrial, antigliadin (IgA and IgG classes), IgA tissue transglutaminase, and IgA endomysial. Hazard ratios (HR) for all-cause mortality in PWE with abnormal immunological markers relative to 413 patients with normal findings were evaluated with adjustment for confounders during a follow-up of nine years. Borderline statistically significant associations were found only for elevated IgA (HR 2.09, 95% CI 0.99–4.42) and for having two or more abnormal antibody titers (HR 1.58, 95% CI 0.98–2.56). The findings of this exploratory study suggested that elevated serum IgA might be associated with excess mortality in PWE.

Increased production of cell-free DNA (cf-DNA), a marker of inflammation, cell death and degeneration, has been observed in stroke and severe traumatic brain injury among other medical conditions. The purpose of the present study was to evaluate the significance of cf-DNA in patients with focal epilepsy.cf-DNA was measured in 167 consecutive well-evaluated patients with focal epilepsy (147 with refractory epilepsy). Epilepsy was characterized based on the patient history, electroclinical findings, neuroimaging results and etiology. 250 healthy individuals served as control subjects.The majority of the patients (125/167; 74.8%) had increased concentrations of cf-DNA. The median concentration of cf-DNA was significantly higher in the patients (0.867 μg/ml) compared to the control group (0.759 μg/ml) (p0.001). Symptomatic etiology was associated with increased concentrations of cf-DNA compared to probably symptomatic etiology (p=0.036).The study confirms that the release of cf-DNA is more active in symptomatic refractory focal epilepsy, whereas this process is less pronounced in patients with unknown cause of epilepsy.

Purpose To assess the impact of the new AEDs on overall outcome for patients with epilepsy. Methods In 2004, the effect of combination therapy on seizure frequency in adult patients with focal epilepsy was evaluated in a cross-sectional study in our center. We repeated this analysis ten years and eight new antiepileptic drugs (AED) later. Results In 2014, a higher percentage of patients with polytherapy (117 out of 396; 30%) were seizure-free compared with the original analysis (22%) (p=0.042). Eighty three out of 218 (38%) subjects on duo-therapy were seizure-free (27% in 2004) (p=0.040); in the 151 receiving triple therapy there were 30 (20%) seizure-free subjects (10% in 2004). Four out of 27 subjects (15%) with four AEDs were seizure-free (0% in 2004). The most common pairing of 52 different combinations for duo-therapy was levetiracetam-oxcarbazepine. Eighty different AEDs regimens were being used in the patients administered three AEDs. Conclusion Our combined data from these two studies indicate that some patients with focal epilepsy might benefit from newer AEDs as an adjunctive therapy in the hope they could acquire seizure freedom.

Increased prevalence of autoantibodies has been suggested in patients with epilepsy. This study determined the presence of autoantibodies in a representative cohort of 960 patients with epilepsy. The frequency of antinuclear antibodies (ANA), immunoglobulin G class anticardiolipin antibodies (aCL) and anti-B2-glycoprotein I antibodies were studied in 960 consenting adult patients with epilepsy and in 580 population-based reference subjects identified from the Finnish Population Registry. Overall the frequencies of the autoantibodies studied did not differ between patients with epilepsy and reference subjects. aCL were present in 4.5% of the patients and in 5.0% of the reference subjects and 17% of both the patients and the reference subjects had antinuclear antibodies. However, patients with partial epilepsy foror =30 years were three times more likely to have aCL than patients with partial epilepsy for10 years. Patients with partial epilepsy andor=1 seizure per month were 2.2 times more likely to have aCL than patients with partial epilepsy with1 seizure per month. Moreover, ANA tended to be more frequent among patients withor =1 seizure per month. No association was found between the major antiepileptic drugs and autoantibodies. Overall the frequencies of the autoantobodies studied were similar in the large epilepsy cohort and in matched reference subjects from the general population. However, a long duration of epilepsy and poor seizure control were associated with an increased presence of aCL in patients with partial epilepsy.