CEREBROSPINAL-FLUID EXAMINATIONS IN CRYPTOGENIC WEST AND LENNOX-GASTAUT SYNDROME BEFORE AND AFTER INTRAVENOUS IMMUNOGLOBULIN ADMINISTRATION

Before and after administration of intravenous immunoglobulin (IVIg), cerebrospinal fluid (CSF) was examined in a homogeneous group of 15 pa tients with cryptogenic types of West syndrome (WS) and Lennox-Gastaut syndrome (LGS). The purpose of the present CSF study was: (i) to eluc idate possible etiological factors and consequences of these severe fo rms of epilepsy, and (ii) to elucidate mechanisms of action and advers e effects of IVIg. Hypotheses concerning etiological factors like cent ral nervous system infections, neuroimmunological disorders, or distur bances in neurotransmitter metabolites could not be confirmed. These n ormal CSF findings are in accordance with the concept of a cryptogenic etiology of the epilepsies in the reported patients. Nor could we con firm hypotheses concerning seizure consequences, such as increased blo od-CSF permeability, increased markers of brain cell destruction, or i ncreased metabolic components. Following IVIg administration in these patients, all with an on the whole undisturbed blood-CSF barrier perme ability as measured by Q albumin, the CSF IgG concentrations increased significantly and proportionally to the Q albumin level. No signs of adverse effects of IVIg such as aseptic meningoencephalitis were found in 165 infusions of IVIg performed in the 15 children.