Dokument

Zusammenfassung:
Entzündungsmechanismen sind an der Pathogenese verschiedener Epilepsien beteiligt. Andererseits werden Immunfunktionen durch neuronale Aktivität beeinflusst. Um die funktionellen Beziehungen zwischen der Temporallappenepilepsie (TLE) und dem Immunsystem zu charakterisieren, wurden unter Berücksichtigung möglicher modifizierender Faktoren die postiktalen Änderungen der Serumkonzentration der immunmodulatorischen Zytokine IL-1β, IL-6 und TNFα bei Patienten mit gut charakterisierter TLE bestimmt. Die Zytokinkonzentrationen wurden bei 25 Patienten mit eindeutiger TLE während eines Video-EEG-Monitorings vor und unmittelbar nach komplex fokalen oder sekundär generalisierten Anfällen sowie eine und 24 Stunden später gemessen. IL-6 stieg unmittelbar postiktal um 51% an (p<0.01) und blieb in den folgenden 24 Stunden erhöht. Dieser Anstieg fehlte bei Patienten mit Hippokampussklerose (HS: n=16, mittlerer Anstieg 28 %, p>0.5, vs. 112%, p<0.01 bei Patienten ohne HS). Die IL-6-Konzentrationen waren 24 Stunden nach rechtshemisphärischen Anfällen höher als nach linkshemisphärischen Anfällen (8,7 pg/ml vs. 3,4 pg/ml, p<0.05). Bei Patienten unter Valproattherapie fanden sich höhere IL-1β-Konzentrationen als bei Patienten, die kein Valproat einnahmen. Die Resultate legen eine Beziehung zwischen dem Zytokinhaushalt und spezifischen Charakteristika von Temporallappenepilepsien (z. B. Lateralisation und Ätiologie) sowie einen Einfluss von Valproat auf den Zytokinmetabolismus nahe. Für die Einschätzung der pathophysiologischen Relevanz sind weitere vorwiegend tierexperimentelle Untersuchungen erforderlich.

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